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Retirement Allowance Estimate Request - CalPERS

This is a Request for an Estimate of your potential CalPERS Retirement benefit amounts. You must be within one year of your anticipated Retirement date to use this form. You are limited to two Estimate requests within a 12-month period. Retirement Allowance Estimate RequestYour Name (First Name, Middle Initial, Last Name) Social Security Number or CalPERS IDBirth Date (mm/dd/yyyy) Daytime Phone Alternate PhoneAddressCity State ZIP( )( )Enter the address wehave on file for you. If you need to updateyour address, see the back of this form for instructions. Section 1 Information About You Section 2 your Retirement InformationYou can only select one type of Retirement Estimate per is a survivor vs. a beneficiary? See the back of this form for details and a complete description of the available Retirement payment one type: c Service Retirement c Disability Retirement c Industrial Disability RetirementMy projected Retirement date is:Employer Position TitleTo include your unused sick leave and/or educational leave in your Estimate , enter the number of hours you ll have as of your projected Retirement date.

This is a request for an estimate of your potential CalPERS retirement benefit amounts. You must be within one year ... your monthly benefit to your named beneficiary upon your death. If your beneficiary dies before you, or if you have another ... regarding confidentiality. Your Rights You have the right to review your membership

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