TDA Annuitization Election Form (code TD6)

TDA ANNUITIZATION ELECTION FORM
INSTRUCTIONS
PLEASE READ CAREFULLY
Filing Information
As a member of the Teachers’ Retirement System of the City of New York (TRS), you may apply for an annuity under the
Tax-Deferred Annuity (TDA) Program by filing a “TDA Annuitization Election Form” (code TD6). If you are filing this form
in conjunction with retirement under the Qualified Pension Plan (QPP), TRS must receive your application at least one
business day, but no more than 90 days, before your effective retirement date. Pending TRS’ review and approval, filing
your application will enable you to receive monthly payments of your annuity. Please note that your TDA annuitization
date would be the same as your retirement date under the QPP. If you are a retired TRS member who initially elected
TDA Deferral status, you may apply for an annuity under the TDA Program and select an annuitization date that is at least
one business day before, but no more than 90 days after, TRS receives your application.
When you file the completed “TDA Annuitization Election Form,” you must attach proof of your date of birth and your
beneficiaries’ dates of birth (if applicable). The following items are considered acceptable proof of date of birth, and only
one of the following is required: birth certificate; passport; or naturalization document. If none of these items are available,
then two of the following are required: certificate of military record; affidavit of older relative; baptismal certificate; life
insurance policy; government-issued identification; or driver’s license. (Photocopies are acceptable for all items.) We
suggest that you bring all materials in person to TRS’ Member Services Center at 55 Water Street in lower Manhattan.
Please retain a photocopy of your application and all forms filed in conjunction with retirement for your records.
Cancellation or Change of Information
You may change your annuitization date under the TDA Program, election of options, or any Passport Fund election
on your application after you have submitted it; however TRS must receive your changes no later than one day before
your effective retirement date, except for your payment option election, which may be changed up to 30 days after your
effective retirement date, by filing the “TDA Annuitization Option Change Form For Tiers I/Il Members Only” (code RW87).
To make changes to your application, you may visit TRS’ Walk-In Center on the 2nd floor of 55 Water Street in lower
Manhattan and review your changes with a Member Services Representative. If you cannot visit the Walk-In Center, but
wish to make changes to your application, then you must cancel your “TDA Annuitization Election Form” and submit a new
one. You may cancel your application by submitting a “Request for Withdrawal of Form/Application” (code MI5). TRS
must receive this form at least one day before your effective annuitization date, regardless of the date on which you mailed
the form or the postmark date on the form. Please note that you may NOT cancel your “TDA Annuitization Election Form”
on or after your effective annuitization date, and withdrawals from your TDA account may not be made on or after your
annuitization date.
General
• You should keep TRS informed of any change to your beneficiaries’ mailing addresses by notifying us in writing.
• For your convenience, TRS forms and publications are available on our website. If you require additional assistance, we
encourage you to contact our Member Services Center at 1 (888) 8-NYC-TRS.
TD6
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HOW TO COMPLETE THE TDA ANNUITIZATION ELECTION FORM
In Part A: PERSONAL INFORMATION
All information must be provided.
In Part B: TDA ANNUITIZATION DATE ELECTION
Please select one of the statements to designate your annuitization date.
In Part C: PAYMENT OPTION ELECTION AND BENEFICIARY DESIGNATIONS
You must elect ONLY ONE payment option in Part C for your monthly annuity payments and designate beneficiaries if your
payment option includes that provision. In all cases, you would receive your monthly annuity payments for as long as you live. If you
want to provide for beneficiaries, you have several choices, each of which would reduce the amount of your monthly annuity payments.
All payments to you and your beneficiaries are monthly and each payment option also enables you to choose a beneficiary for the
fractional amount of your retirement allowance. You may add additional beneficiaries by filing a “Retired/Retiring Member’s Additional
TDA Beneficiary Form” (code EN23). For additional information about payment option elections, beneficiaries, and acceptable
documents to prove your date of birth, please see the Retirement Payment Options: Tiers l/ll and TDA Annuitization Options brochure.
Please note that you may designate a trustee only for lump-sum payments.
Your payment options are categorized as follows:
Maximum Payment Option
Continuing Payment Options
Lump-Sum Payment Options
• Option ll
• Option lll
• Option lV-a
Pop-up Options
• Option l
• Option lV-b
Guaranteed Number of Payments Options
• Option lV-d (5-Year Certain)
• Option lV-e (10-Year Certain)
• Option lV-2
• Option lV-3
• Option lV-4
If you elect a Continuing Payment or Pop-up Option:
• These options provide for only one beneficiary. You may change this beneficiary designation up to 30 days after your initial
payability date.
• Your beneficiary’s age is a factor in computing the amount of your monthly annuity payments; therefore, you must submit
proof of your beneficiary’s date of birth in conjunction with this application.
• You may not designate a trustee as your beneficiary.
In Part D: DESIGNATION OF BENEFICIARY FOR FRACTIONAL PAYMENT OF ANNUITY
In addition to any election you may have made in Part C, you must designate a beneficiary in Part D to receive any fractional payment
that may be due for the month in which you die. The fractional payment would be payable provided that you do not die on the last
day of the month; the payment would be based on the number of days that you are alive during that month. For example, if you
die on the 21st day of a 30-day month, the beneficiary that you designate would receive a payment equaling 21/30 (or 70%) of your
monthly annuity.
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• T
he beneficiary you designate to receive your fractional payment need not be the same beneficiary as you designate
in Part C.
• You may change your fractional beneficiary designation at any time after you file the “TDA Annuitization Election Form”
by filing a “TDA Change of Fractional Beneficiary Form” (code EN25).
• If you have already established a trust, you may designate your trustee as your beneficiary.
• If your beneficiary predeceases you, the fractional payment would be made to your estate.
In Part E: INVESTMENT ELECTION AT ANNUITIZATION
At annuitization, you have the opportunity to reallocate your accumulated TDA funds among TRS’ Passport Funds. If you elect to do
so, investment allocation changes must be in 5% multiples. The example below demonstrates how to allocate 50% of your TDA funds
in the Fixed Return Fund, 10% in the Diversified Equity Fund, the International Equity Fund, and the Inflation Protection Fund, 5% in
the Bond Fund, and 15% in the Socially Responsive Equity Fund. (This is only an illustration, not a recommendation.) Your TDA funds
will be reallocated on your initial payability date according to the percentages you indicate on this application.
TRS’ Passport Funds
Percentage
Fixed Return Fund
5
0
%
Diversified Equity Fund
1
0
%
5
Bond Fund
E
L
P
M
International Equity Fund
1
0
%
%
Inflation Protection Fund
1
0
%
Socially Responsive Equity Fund
1
5
%
0
0
%
EXA
TOTAL
1
Note: Any ongoing conversion of your funds that is not completed by your initial payability date would stop as of that date.
You may change the way your TDA funds are invested, on a quarterly basis, by filing a “TDA Annuitant’s Investment Election Change
Form” (code RP9) with TRS at any time. Investment election changes take effect on the following conversion dates: April 1,
July 1, October 1, and January 1. Your elections would take effect on the next conversion date that occurs at least 60 days after TRS
receives your form. Please be advised that investment election changes cannot be effected until the quarter after your TDA annuity
has been finalized.
In Part F: AFFIRMATION OF UNDERSTANDING
You must sign and date the statement shown in the presence of a notary public, who must then complete Part G.
In Part G: NOTARIZATION
You must have this form notarized. The date in this notary section must be the same date that you enter in Part F.
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TDA ANNUITIZATION ELECTION FORM
Please print in black or blue ink, and initial any changes that you make on this application. For each selection that you make
throughout this application, you must write your initials in the space provided and check the corresponding box.
PART A: PERSONAL INFORMATION All information must be provided below.
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
Mobile)
Work
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:
PART B: TDA ANNUITIZATION DATE ELECTION
Please select one of the statements below to designate your annuitization date:
_____I am filing in conjunction with service or disability retirement. I hereby designate my initial payability date of my TDA annuity
to be (M/D/Y):
(This initial payability date cannot be earlier than the effective date of your retirement under the Qualified Pension Plan.)
_____I am retired and filing under TDA Deferral status. I hereby designate my initial payability date of my TDA annuity
to be (M/D/Y):
(This initial payability date can be at least one business day before but no more than 90 days after TRS receives your
application.)
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PART C: PAYMENT OPTION ELECTION AND BENEFICIARY DESIGNATIONS
Please choose ONLY ONE of the payment options listed in Part C. Choose and complete any additional elections under your payment
option. If you elect an option that provides a death benefit, you must designate a beneficiary. In addition, all options require a
beneficiary for your fractional payment. If you have already established a trust, you may designate your trustee as your
beneficiary for lump-sum payments only.
If you need to designate additional beneficiaries (primary, contingent, or fractional), please file a “Retired/Retiring Member’s
Additional TDA Beneficiary Form” (code EN23).
For more information about the percentage of your retirement allowance that you can leave your beneficiaries, please see the
Retirement Payment Options: Tiers l/ll and TDA Annuitization Options brochure.
MAXIMUM PAYMENT OPTION
_____
Maximum Payment Option
THEN
Go to Part D to designate a beneficiary for a fractional payment.
Highest monthly retirement allowance
LUMP-SUM PAYMENT OPTIONS
_____
Payment to Beneficiaries
If you die before your monthly annuity payments deplete your
initial reserves, the remaining balance would be made payable
in a lump sum to your beneficiaries.
Option I
OR
_____
Option IV-b
Indicate lump-sum payment to your beneficiaries:
$
THEN
TD6 (8/11) ,000.
This option enables you to specify the lump-sum dollar
amount to be paid to your beneficiaries upon your death. It is
not reduced by the annuity payments you receive.
Designate your primary and contingent beneficiary on the next page; then go to Part D to designate a beneficiary for a
fractional payment.
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Part C (Continued)
LUMP-SUM PAYMENT OPTIONS
DESIGNATION OF PRIMARY BENEFICIARY
Beneficiary/ Trustee
Home Address
First Name/ MI
Last Name
Relationship
To You
Date of Birth (M/D/Y)
SSN#
DESIGNATION OF CONTINGENT BENEFICIARY
Beneficiary/ Trustee
Home Address
First Name/ MI
Last Name
Relationship
To You
Date of Birth (M/D/Y)
SSN#
GUARANTEED NUMBER OF PAYMENTS OPTIONS
_____
Payment to Beneficiaries
Receives payments only if 60 payments have not
been made before your death.
Option IV-d (5-year certain)
OR
_____
THEN
Option IV-e (10-year certain)
Receives payments only if 120 payments have not
been made before your death.
Designate your primary and contingent beneficiary below; then go to Part D to designate a beneficiary for a
fractional payment.
DESIGNATION OF PRIMARY BENEFICIARY
Beneficiary/ Trustee
Home Address
First Name/ MI
Last Name
Relationship
To You
Date of Birth (M/D/Y)
SSN#
DESIGNATION OF CONTINGENT BENEFICIARY
Beneficiary/ Trustee
Home Address
First Name/ MI
Last Name
Relationship
To You
Date of Birth (M/D/Y)
SSN#
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PART C (Continued)
CONTINUING PAYMENT OPTIONS
_____
Option II
_____
Option III
_____
Payment to Beneficiary
Lifetime payments equal to 100% of your
reduced monthly annuity payments
OR
OR
Option IV-a
Choose a percentage of your monthly retirement
allowance payable as death benefit: %
(50% and 100% not permitted.)
Lifetime payments equal to 50% of your
reduced monthly annuity payments
Lifetime payments of your choice
OR
_____
Lifetime payments equal to 100% of your
reduced monthly annuity payments. Lifetime
payments as in Option ll.
Option IV-2 (“Pop-up” option)*
OR
_____
Option IV-3 (“Pop-up” option)*
_____
Option IV-4 (“Pop-up” option)*
Lifetime payments equal to 50% of your
reduced monthly annuity payments. Lifetime
payments as in Option lll.
OR
Choose a percentage of your monthly retirement
allowance payable as death benefit: %
(50% and 100% not permitted.)
Lifetime payments of your choice. Lifetime
payments as in Option lV-a.
*If beneficiary predeceases you, your payments increase to the maximum.
THEN
Designate a primary beneficiary below; then go to Part D to designate a beneficiary for a fractional
payment.
DESIGNATION OF PRIMARY BENEFICIARY
Beneficiary
Home Address
First Name/ MI
Last Name
Relationship
To You
Date of Birth (M/D/Y)
SSN#
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PART D: DESIGNATION OF BENEFICIARY FOR FRACTIONAL PAYMENT OF ANNUITY
(All Payment Options)
Regardless of your election in Part C, you must designate a beneficiary to receive the fractional portion of your retirement
allowance for the month in which you die.
Beneficiary/ Trustee
Home Address
Relationship
To You
First Name/ MI
Last Name
Date of Birth (M/D/Y)
SSN#
PART E: INVESTMENT ELECTION AT ANNUITIZATION
In the appropriate box(es) below, please designate how you would like your TDA funds allocated among TRS’ investment programs.
Your allocations must be in 5% multiples and add up to 100%. Your TDA funds will be reallocated on your initial payability date
according to the percentages you indicate on this application.
_____
I wish to reallocate my TDA funds as indicated below:
TRS’ Passport Funds
Percentage
Fixed Return Fund
%
Diversified Equity Fund
%
Bond Fund
International Equity Fund
%
%
Inflation Protection Fund
%
Socially Responsive Equity Fund
%
TOTAL
_____
TD6 (8/11) 1
0
0
%
I wish to leave my funds invested as they are as of my annuitization date.
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PART F: AFFIRMATION OF UNDERSTANDING
Please read the following statement and sign and date below in the presence of a notary.
I affirm that, to the best of my knowledge, all information I have provided above is true and correct. I understand that the
filing of this application is irrevocable and cannot be withdrawn as of my initial payability date. I also affirm my understanding
of the following:
CHANGES AFTER FILING: I understand that any changes I wish to make to this form must be made no later than one day
prior to my initial payability date, with the exception of the payment options and beneficiaries that I elected in Part C, which
may be changed within 30 days after my initial payability date.
TERMS OF PAYMENT: If TRS determines that my retirement benefits from TRS are overstated, I am required to repay (or my
beneficiaries may be required to repay) the resulting deficit amount in full, in accordance with TRS’ applicable rules.
If my retirement allowance payments are transmitted electronically to my financial institution, I authorize and direct my finacial
institution to immediately refund any overpayments to TRS, including all payments made by TRS on or after the date of
my death, and to charge the same to my bank account. TRS’ certification of overpayment shall be sufficient evidence of an
overpayment.
If the funds remaining are not sufficient to permit my financial institution to fully refund overpayments by TRS, I authorize and
direct my financial institution to provide to TRS all information related to the designated account, including withdrawals after
the first of the month in which my death occurs, the names and addresses of all joint account holders and any individuals
authorized to withdraw funds from the designated account, and any changes of address within one year prior to the date of
my death.
MEMBER’S SIGNATURE _________________________________________________ DATE (M/D/Y) ________________
PART G: NOTARIZATION
TO BE COMPLETED BY A NOTARY (NOTE: Attestation made outside the U.S. must be executed before an American consul.)
State of ________________________________)
) s.s.:
County of _______________________________ )
On the _______________ day of __________________________, __________, before me personally appeared the
person known to me to be __________________________________________________________________________, the
individual who executed the foregoing instrument and acknowledged to me that (s)he executed the same.
Signature: ___________________________________________________________
Official Title: _________________________________________________Expiration Date of Commission: _______________
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