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

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* PRIVACY NOTICE
INVESTMENT DIRECTION
All Social Security Numbers are requested by this
agency in accordance with the requirements of
State Form 48970 (R4 / 8-08)
the Internal Revenue Code.
Disclosure is
mandatory; this form will not be processed without
the information
Name of member (first, middle initial, last)
Member’s Social Security Number *
         
Address (number and street)
City
State
Zip code
You have the right to change your investment direction at any time while you maintain a balance in your Annuity Savings
Account. However, your change will not take effect until 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. In choosing your investment directions,
please make sure the percentages total 100%, or it will be returned. Investments may only be made in increments of
10%. This form must be correctly completed and signed in order to take effect.
Please return this form to PERF at the following address:
Public Employees’ Retirement Fund
143 West Market Street
Indianapolis, IN 46204
Fax: (317) 234-5922
If you have not received a confirmation notice within three (3) weeks of mailing this form, please call the Public
Employees’ Retirement Fund TOLL-FREE at 888-526-1687.
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
International Equity Index Fund
The total of all selections must equal 100%.
I revoke any previous investment directions and hereby direct the above investments, effective this date.
Signature of member
Date (month, day, year)

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