benefits request form

* Full Name

Employee ID

Daytime Phone

* Last 4 Digits SS#

Date of Employment

* Email

Department

Buyback Estimates(s) Requested:

Military (*DD214 Required)

Has this service been purchased?

Yes

No

Prior City Service

Has this service been purchased?

Yes

No

Out-of-City Public Service
Out of City Public Verification Form

Has this service been purchased?

Yes

No

(Verification form must be completed and submitted by previous employer.)

Comments:

Submitted by:

* How would you like to receive your estimate?

Acknowledgement:
I understand that estimates are completed in the order they are received and it may take up to six weeks for me to receive an estimate.
I also acknowledge there is a maximum of two calculations per retirement type in a calendar year I can receive from an analyst.
Additional calculations within a calendar year can be provided by utilizing the pension calculator on the Retirement Website.

Benefits Estimate Request Form

Estimate(s) Requested: (Check All that apply):

Buyback Estimates(s) Requested: