Fillable Retirement Plan Election Form For Printed Letters printable pdf download

RETIREMENT PLAN ELECTION FORM

(For employees hired/eligible on or after Aug. 1, 2005)

You will have 120 days from the starting date of your employment to complete and return this election form to the Human Resources

Department at your institution. If you want to become a member of an Ohio state retirement system, simply check the appropriate box in

Section II below. If you want to participate in an alternative retirement plan (ARP) offered by a private plan provider, check the appropriate

box in Section II below and select one of the plans. If you do not elect to participate in an ARP or do not return this form within the pre-

scribed time period, you will be enrolled in the applicable state retirement system.

Section I — Biographical Information (Please print or type.)

Name

Social Security no.

First

Middle initial

Last

Address

Telephone number

Date of birth

Gender

Male

City

State

ZIP code

Employee identification number

Hire date

If applicable

Are you receiving a retirement benefit from one of these Ohio retirement systems: HPRS, OPERS, OP&F, SERS or STRS Ohio?

Yes

If “Yes,” which system?

Effective date of retirement

None

Section II — Election (Choose only one.)

I elect to participate in the

I elect to participate in an ARP: (Select only one of the following ARP carriers.

state retirement system for

You must contact your chosen carrier to enroll.)

which I am eligible.

AIG VALIC

Metropolitan Life Insurance Co.

• OPERS*

AIG SunAmerica Life Assurance Co.

Nationwide Life Insurance Co.

• SERS

• STRS Ohio*

AXA Equitable Life Insurance Co.

TIAA-CREF

Great American Life Insurance Co.

The Hartford

I understand that I may not change my

election to participate in the state retirement

ING Life Insurance and Annuity Co.

The Travelers Companies, Inc.

system after my election period expires and

that my election will be irrevocable while

Lincoln National Life Insurance Co.

I am continuously employed in a position at

I understand that by electing to participate in an ARP I am irrevocably waiving my right to

my current college or university.

participate in the eligible state retirement system while I am continuously employed in a position

at my college or university. I also understand that by electing to participate in an ARP offered

*Eligible employees may be able to participate in a

by a private plan provider, I will be forever barred from claiming or purchasing service credit or

defined contribution plan. Contact your applicable retire-

participating in other plans offered by any state retirement system for the period that an election

ment system for more information about these plans and

eligibility.

to participate in an ARP is effective.

Section III — Authorization

I hereby certify the election chosen above in Section II. I understand that I will be able to make an election to participate in another

ARP or Ohio public retirement system if I cease to be continuously employed or am subsequently employed full time by another Ohio

public institution of higher education in a position for which a retirement election is available.

______________________________________________________________________________________

_______________________

Employee’s signature

Date

office of human resources use only

For ARP Elections Only

❏

Applicable state system

OPERS

SERS

STRS Ohio

Contributions made to the applicable state system during

the election period to be forwarded to the ARP provider:

Annual compensation _____________________________________

Amount

Date election form received by college/university _____________

Employee contributions ..............................._______________

First date eligible to participate in an ARP __________________

Total employer contributions ......................._______________

Certified by _______________________________________________

–

Less supplemental contributions ................_______________

Title _____________________________________________________

Employer contributions to ARP provider ...._______________

College/University ________________________________________

Date of last payroll report with employee

contributions to applicable state system ...._______________

Employer code ____________________________________________

4/08/2

ARP-3

Retirement Plan Election Form For Printed Letters

Related Articles

Related forms

Related Categories