Total Service Letter Request Form (for Tiers III, IV, and VI Members

TOTAL SERVICE LETTER REQUEST FORM
(FOR TIERS III, IV, AND VI MEMBERS ONLY)
INSTRUCTIONS
PLEASE READ CAREFULLY
• Please complete this form if you are a Tier III, IV, or VI member requesting a Total Service Letter. If you
are a Tier I or II member, you should file a “Total Service Letter Request Form (For Tiers I/II Members
Only)” (code SD154).
• A
Total Service Letter itemizes your Total Service Credit, which includes your TRS membership service,
any transferred service, and any optional service. Total Service Credit is one of the factors used to
calculate your retirement allowance.
• If you intend to retire within the next 12 months, please indicate your expected date of retirement in
Part B of this form. TRS would prioritize requests from members who are within one year of retirement.
• For more information about creditable service for your tier, please refer to the service credit brochures
on our website.
• For your convenience, TRS forms and publications are available on our website. If you require
additional assistance, please contact our Member Services Center at 1 (888) 8-NYC-TRS.
(NOTE: Please print in black or blue ink, and initial any changes that you make on this form.)
PART A: All information must be provided.
First Name
MI Last Name Permanent Home Address
Social Security Number (last 4 digits only)
XX X X X
Apt. No. TRS Membership Number
City State Zip Code
Primary Phone Number (Check one:
(
)
Alternate Phone Number (Check one:
(
)
Home
Home
Work
Work
Mobile)
Mobile)
Please keep your personal information with TRS up to date. We will update our records based on the information you provide above,
so do not enter a temporary address; instead, TRS suggests that you consult the U.S. Postal Service about having your mail forwarded
on a temporary basis. To register any changes to your permanent address (and/or phone number), please access our website or file a
“Member’s Change of Address Form” (code DM13) with TRS.
If you are providing new information above, please indicate the effective date:
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PART B: To request a Total Service Letter, check the box below and write your initials in the space provided. Please indicate your
expected date of retirement if you intend to retire within the next 12 months.
I hereby request that TRS send me a Total Service Letter at my address above.
Expected date of retirement (if applicable): (MM/DD/YYYY) _______________
PART C: Please sign and date this form.
MEMBER’S SIGNATURE _____________________________________________________ DATE (MM/DD/YYYY) ______________
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