Election Of Retirement Coverage
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2STATE OF NEW JERSEY
ABP-0087-0806
PO Box 295
DIVISION OF PENSIONS AND BENEFITS
Trenton NJ 08625-0295
ALTERNATE BENEFIT PROGRAM
ELECTION OF RETIREMENT COVERAGE
(Please do not complete this form until you have read the reverse side.)
Name_____________________________________________________________________________________
Social Security # ____________________________
Title _________________________________________
Employing Institution _________________________________________________________________________
I certify that I am now a member of:
The NJ Teachers' Pension and Annuity Fund
and my membership number in the Fund is: # _________________________________
The NJ Public Employees' Retirement System
and my membership number is: # ___________________________________________
— SIGN ONE STATEMENT ONLY —
I wish to transfer my pension contributions to the Alternate Benefit Program and waive my statutory right to remain
in or transfer to the Public Employees' Retirement System. I understand that my decision is irrevocable. I wish my
accumulated pension deductions and any contingent reserve funds to which I am entitled to be invested with the
one investment carrier designated below:
_____
AIG VALIC
_____
AXA Financial (Equitable)
_____
The Hartford
_____
ING Life Insurance and Annuity Company
_____
Met Life (formerly Travelers/CitiStreet)
_____
TIAA-CREF
______________________________________________
____________________________
Employee Signature
Date
— OR —
I wish to remain in the Public Employees' Retirement System (PERS) or transfer my pension contributions to the
PERS from the Teachers' Pension and Annuity Fund and waive my statutory right to participate in the Alternate
Benefit Program. I understand that my decision is irrevocable.
______________________________________________
____________________________
Employee Signature
Date
WITNESSED BY OFFICIAL OF EMPLOYING AGENCY
Signature of Official _____________________________________________________________
Title _________________________________________________________________________
Institution _____________________________________________________________________
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