Benefit Estimate Request Form

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Teachers’ Retirement System of Louisiana
Form 10 (02/15)
8401 United Plaza Blvd, Ste 300 • Baton Rouge, LA 70809-7017
03-10
P.O. Box 94123 • Baton Rouge, LA 70804-9123
Telephone: (225) 925-6446 • Fax: (225) 925-4779
Benefit Estimate Request
To receive a retirement benefit estimate, print the information requested below and return completed form to Teachers’ Retire-
ment System of Louisiana. An estimate will be sent to your mailing address below. Please allow four to six weeks for a response.
NOTE: An incomplete or improperly completed form will be returned to you. Please allow four to six weeks for processing after
TRSL has received the necessary information. Please see TRSL’s booklet “Planning for Your Retirement” for more detailed informa-
tion on preparing for your retirement or DROP participation. TRSL uses an average of your highest (three or five, depending on
membership date) consecutive reported earnings to compute your estimate of retirement benefit or DROP deposit amount.
Current salary projections and leave conversions are not considered for estimates. Estimates are computed based on information
already provided to TRSL by your employer(s).
Name ___________________________________________________ Social Security number
Date of birth _____ / _____ / __________
Email address ________________________________________
Street / PO Box ___________________________________________ City, state, zip _______________________________________
(
)
(
)
Work telephone __________________________________________ Home telephone _____________________________________
If you are interested in beneficiary options, please complete the following:
Beneficiary name(s) ______________________________________________ Beneficiary date of birth _____ / _____ / __________
(Date of birth not needed if more than one beneficiary is listed.)
Gender ______________________ Relation __________________________
Projected date of retirement: _____ / _____ / __________
(Must be within 36 months)
Type of retirement benefit estimate desired:
Service
Initial Lump-Sum Benefit (must meet eligibility requirements for DROP)
If Yes, provide youngest child’s date of birth. ____ / ____ / ________
Disability retirement: Minor children?
Yes
No
Deferred Retirement Option Plan (DROP) - (entering DROP)
Retirement (after DROP)
2.5% Annual COLA Option (ACO)
The ACO is a new retirement option that allows a retiring member to receive a guaranteed annual 2.5% cost-of-living adjust-
ment (COLA) by accepting an actuarially reduced retirement benefit. Please check the box below only if you are interested in
receiving a benefit comparison estimate.
2.5% Annual COLA Option
I hereby understand that the figures I will receive are estimated and subject to change once final employer certifications are
received when I retire.
Signature ________________________________________ _____
Date of request _____ / _____ / __________
Visit to use the benefits calculator for an unofficial estimate.
SEND COMPLETED FORM TO: ATTENTION: Retirement Department
Teachers’ Retirement System of Louisiana
PO Box 94123
Baton Rouge LA 70804-9123

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