Fillable Address Nycers Form in PDF
The Address Nycers form serves a crucial purpose for members of the New York City Employees Retirement System (NYCERS) who need to update their address on file. This form is essential for ensuring that all correspondence, including pension payments, reaches the member at their current location. When filling out the form, members must provide their personal details, including their member number, pension number, and the last four digits of their Social Security number. It’s important to include both the new and previous addresses, along with any relevant information regarding a change in banking arrangements for monthly payments. Additionally, the form requires a signature from the member and must be notarized to validate the request. For any questions or assistance, members can contact the NYCERS Call Center directly. This straightforward process helps maintain accurate records and ensures that retirees continue to receive their benefits without interruption.
Preview - Address Nycers Form
NYCERS USE ONLY |
F290 |
Mail completed form to: *290*
Long Island City, NY 11101
Change of Address Form
This application is for members who wish to change their address that NYCERS has on file. Should you have any questions regarding this application, please contact our Call Center at
Member Number OR
First Name
Pension Number |
Last 4 Digits of SSN |
M.I. Last Name
Phone Number
( )
New Address:
IN CARE OF (IF APPLICABLE)
Address |
Apt. Number |
City |
State |
Zip Code
Previous Address:
IN CARE OF (IF APPLICABLE)
Address |
Apt. Number |
City |
State |
Zip Code
If you are currently receiving monthly payments from NYCERS, check one of the following boxes only.
Continue sending my check to the bank.
OR
Cancel sending my check to the bank.
Please send my check to my new address, as listed above.
Signature of Member |
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Date |
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This form must be acknowledged before a Notary Public or Commissioner of Deeds |
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State of |
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County of |
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On this |
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day of |
2 0 |
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, personally appeared |
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before me the above named, |
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, to me known, and known to |
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me to be the individual described in and who executed the foregoing instrument, and he or she acknowledged to me that he or she
executed the same, and that the statements contained therein are true. |
If you have an official seal, affix it |
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Signature of Notary Public or |
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Commissioner of Deeds |
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Official Title |
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Expiration Date of Commission |
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R12/16 |
Page 1 of 1 |
Form Characteristics
| Fact Name | Description |
|---|---|
| Purpose | This form is used by members of NYCERS to officially change their address on file. |
| Contact Information | Members can reach NYCERS for questions regarding the form at 347-643-3000. |
| Notarization Requirement | The form must be acknowledged by a Notary Public or Commissioner of Deeds to be valid. |
| Governing Law | This form is governed by New York State laws regarding pension and retirement systems. |
More PDF Templates
Where Can I Get a Copy of My Marriage License - A section is dedicated to identifying the individual requesting the search, their relationship to the marriage, and their contact information, ensuring responsible use of the requested records.
Nycers F291 - Through the accurate completion of F291, NYCERS members can ensure their name change is officially documented.