State Form 48970 - Investment Direction Form - Public Employees' Retirement Fund Of Indiana

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Investment Direction Form
Public Employees' Retirement Fund
State Form 48970 (R1/6-99)
Approved by the State Board of Accounts 1998
Member's Name: First, Middle, (Maiden), Last
Member's Social Security Number
Member's Address:
Street
City
State
ZIP
You have the right to change your investment direction at any time while you maintain a balance in your Annuity
Savings Account. However, you may do so only once every twelve (12) months, to take effect on the first day of the
next calendar quarter ( January 1, April 1, July 1, or October 1). This form must be received at least thirty (30) days
prior to the date it is to take effect. If you leave PERF-covered employment, and leave your money with the Fund,
you still retain the right to direct the investment of your account.
This form revokes and replaces all previously selected investment directions. You must list all of your investment
directions and the percentages must total 100%, or it will be returned. Investments may only be made in increments
of 10%. This form must be signed in order to take effect.
Your investment options can only be changed by filing this form with PERF at the following address:
Public Employees' Retirement Fund
143 West Market Street
Suite 500
Indianapolis, IN 46204
According to the IRS Code, Section 6041(A), this agency is required to obtain your Social Security Number. This
form cannot be processed without it.
If you have not received a confirmation notice within 3 weeks of mailing this form, please call the Investment Call
Center at 888-526-1687, then press 2.
10% 20%
30% 40%
50% 60%
70%
80% 90% 100%
Guaranteed Fund
Money Market Fund
Bond Fund
S&P 500 Index Fund
US Small Companies Stock Fund
The total of all selections must equal 100%
I revoke any previous investment directions and hereby direct the above investments, effective this date.
Member's Signature
Date

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