Form Orp-3 - Optional Retirement Program Of The University Of North Carolina Acknowledgement Of Particpation Page 5

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OPTIONAL RETIREMENT PROGRAM OF THE UNIVERSITY OF NORTH CAROLINA
FORM
ACKNOWLEDGEMENT OF PARTICPATION
ORP-3
SECTION D. EMPLOYER CERTIFICATION (TO BE COMPLETED BY YOUR UNC HUMAN RESOURCES OFFICE)
EMPLOYEE NAME
SOCIAL SECURITY NUMBER
EMPLOYMENT DATE
TERMINATION DATE
UNC ORP PARTICIPATION (SELECT ALL THAT APPLY)
DATES OF UNC ORP PARTICIPATION
FIDELITY
LINCOLN
TIAA-CREF
VALIC
FROM
TO
OTHER NORTH CAROLINA RETIREMENT PLAN MEMBERSHIP
DATES OF OTHER NORTH CAROLINA RETIREMENT PLAN MEMBERSHIP
TSERS
LGERS
CJRS
FROM
TO
UNC CAMPUS REPRESENTATIVE SIGNATURE
DATE:
UNC GENERAL ADMINISTRATION CERTIFICATION
VESTED
NOT VESTED
PLAN ADMINISTRATOR (OR DESIGNEE) SIGNATURE
SECTION E. ORP VENDOR CERITFICATION (FOR RETIREMENTS ONLY)
UNC ORP VENDOR
PARTICIPANT NAME:
FIDELITY
LINCOLN
TIAA-CREF
VALIC
ORP MONTHLY RETIREMENT BENEFIT STARTING DATE
VENDOR REPRESENTATIVE SIGNATURE
DATE
Form ORP-3 (Rev. 11/12)
FORM DISTRIBUTION WORKFLOW
RETIREMENTS:
Employee completes the form and the UNC Campus validates information and then sends the form to UNC General
Administration to verify vesting.
UNC General Administration validates vesting and sends the form onto the ORP vendor for verification that benefit payments
have started.
ORP vendor certifies that benefit payments have started and returns the form to the UNC Campus.
Once all validations are processed, copies should be distributed to: Department of State Treasurer Retirement Systems Division,
UNC Campus and Employee.
TRANSFER TO ANOTHER UNC CAMPUS, NEW JOB OPPORTUNITY & OTHER:
Employee completes the form.
UNC Campus validates information and then sends the original to UNC General Administration to verify vesting.
UNC General Administration validates vesting and sends the form onto the ORP vendor.
Once all validations are processed one copy is retained by the UNC Campus and one copy is given to the employee.

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