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Fillable Nycers F321 Form in PDF

The NYCERS F321 form is an application used by members of the New York City Employees' Retirement System to request the transfer of their accumulated salary deductions to another retirement system within New York State. This form ensures that members can move their funds securely while releasing NYCERS from any liability related to the transfer. Understanding the details and requirements of this form is essential for a smooth transition between retirement systems.

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Article Guide

The NYCERS F321 form plays a crucial role for members of the New York City Employees' Retirement System who wish to transfer their accumulated salary deductions to another retirement system within New York State. This application not only allows members to move their funds, including accrued interest, but also requires them to formally release NYCERS from any liability related to this transfer. Members must provide essential information such as their member number and the last four digits of their Social Security number. Additionally, the form captures details about the member's previous and current employment, ensuring that the transfer aligns with their new retirement system. For those who participated in specific programs under Chapter 96 of the laws of 1995, the F321 form also offers the option to request a refund of additional member contributions. Completing this form involves signing and notarizing it, adding an extra layer of security and authenticity to the process. Understanding the F321 form is vital for ensuring a smooth transition of retirement benefits, making it an important document for NYCERS members navigating their retirement options.

Preview - Nycers F321 Form

NYCERS USE ONLY	F321

*321*

Application for Transfer of Member’s Accumulated Salary

Deductions to Another Retirement System Within New York State

Member Number Last 4 Digits of SSN

I, the undersigned, do hereby make application to have the accumulated salary deductions, and accrued interest on the same, standing to my credit in the New York City Employees' Retirement System (NYCERS) transferred to my membership

in the

Retirement System.

In consideration of the transfer of such amount, and upon the transmittal of such funds to the retirement system to which I am transferring, I do hereby release and discharge from any and all liability the New York City Employees' Retirement System in connection therewith.

My City service in the position of

ceased on the		day of

with the Department of

, 20

with the Department of

.I have accepted a position as a(n)

on the

day of

I hereby authorize NYCERS to draw a check made payable to the retirement system of which I am now a member, to be credited to my account in that retirement system under Membership Number

For Tier 2 and Tier 4 members who participated in a special program enacted by Chapter 96 of the laws of 1995 only.

If eligible, I hereby elect to receive a refund of my share of the ADDITIONAL MEMBER CONTRIBUTIONS required to have been contributed by me due to my participation in one of the programs enacted by Chapter 96 of the Laws of 1995 and which are now to my credit in NYCERS in my Retirement Reserve Fund account.

Signature of Member

First Name	M.I.	Last Name

In Care of (if applicable)

Address		Apt. Number

City	State		Zip Code

Home Phone Number

()

Work Phone Number

()

Sign this form and have it notarized, Page 2

R07/26/11

Page 1 of 2

NYCERS USE ONLY	F321

Member Number	Last 4 Digits of SSN

Signature of Member	Date

This form must be acknowledged before a Notary Public or Commissioner of Deeds

State of

County of

On this

day of

2 0

, personally appeared

before me the above named,

, to me known, and known to

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
Signature of Notary Public or
Signature of Notary Public or
Commissioner of Deeds

Official Title

Expiration Date of Commission

Sign this form and have it notarized, THIS PAGE

R07/26/11

Page 2 of 2

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Form Characteristics

Fact Name	Details
Form Purpose	The NYCERS F321 form is used to apply for the transfer of a member's accumulated salary deductions to another retirement system within New York State.
Member Information	Applicants must provide their member number and the last four digits of their Social Security Number (SSN) on the form.
Transfer Authorization	By signing the form, members authorize NYCERS to transfer their accumulated salary deductions and accrued interest to the new retirement system.
Release of Liability	Members release NYCERS from any liability related to the transfer upon completion of the transaction.
Notarization Requirement	The form must be signed in the presence of a Notary Public or Commissioner of Deeds to be valid.
Eligibility Criteria	This form is specifically for Tier 2 and Tier 4 members who participated in a special program under Chapter 96 of the Laws of 1995.

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