Transcription of BENEFIT ESTIMATE REQUEST PUBLIC EMPLOYEES …
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BENEFIT ESTIMATE REQUEST PUBLIC EMPLOYEES …
State of West Virginia Consolidated PUBLIC retirement Board Internet Form (Signature in Blue Ink Only) 4101 MacCorkle Avenue SE, Charleston, West Virginia 25304-1636 Telephone: 304-558-3570 or 800-654-4406 Fax: 304-558-1394 BENEFIT ESTIMATE REQUEST PUBLIC EMPLOYEES retirement SYSTEM (PERS) Please complete and return the following information to this office to obtain an ESTIMATE of your retirement benefits. Upon receipt of this information, the Consolidated PUBLIC retirement Board will prepare an ESTIMATE of your retirement benefits. Important Notice: An ESTIMATE is merely advisory in nature and is not binding upon either the retirement Board or the Member. Name:_____ SSN (Last 4 digits only):_____ Address: _____ Date of Birth: _____ City/State:_____ Zip Code:_____ Home Phone#:_____ Current Employer:_____ Work Phone #:_____ I anticipate my last day of work will be:_____(Date must be provided in order to calculate ESTIMATE ) Beneficiary Name:_____ Beneficiary Date of Birth:_____ Relationship:_____ Beneficiary SSN (Last 4 Digits Only):_____ Have you purchased or reinstated service within the last year?
State of West Virginia Consolidated Public Retirement Board Internet Form (Signature in Blue Ink Only) 4101 MacCorkle Avenue SE, Charleston, West Virginia 25304-1636
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