Form 18- H - Service Retirement Application
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3(Rev. 2/2012)
Instructions For Completing Service Retirement Application – Form 18-H
(Hybrid Plan)
An application for retirement must be received in the Employees’ Retirement System (ERS) office as early as 150 days
st
before but not less than 30 days before the retirement date. Your retirement date must be the 1
of the month except for
st
st
December when retirement can be either the 1
of the 31
of the month. It cannot be the same day as your last day of
work.
The following instructions will help you complete the application form. Please call the ERS Honolulu office at (808) 586-1735
if you need further assistance.
I.
PERSONAL DATA
Name: Last, first, and middle name.
Social Security Number: Your 9-digit number.
Mailing or PO Box Address: Address for the receipt of ERS mail. (Note: Any change in your mailing address must be
reported to the ERS in writing to ensure proper delivery of notices, statements, and tax forms to you).
st
st
st
Retirement Date: Your retirement date must be the 1
day of a month or the 1
or 31
day of December. It cannot be
the same day as your last day of work.
Date of Birth: The month, day, and year of your birth. Please provide both the original document and a photocopy of it
for birth date verification. Acceptable documents include:
•
Certified copy of your birth certificate; or
•
Original baptismal certificate recorded before age five; or
•
Written verification from Social Security if you are age 62 or over.
If one of the above is not available, submit any two of the following:
•
Original baptismal certificate/religious record with birth date or age and recorded after age five
•
Valid Hawaii driver’s license
•
Hawaii State Identification card
•
Passport
•
Foreign passport with birth date or age
•
Marriage record with birth date or age
•
Naturalization record with birth date or age
•
Voter registration record
•
Census record
•
Military record with birth date or age
•
Hospital treatment record with birth date or age
•
Life insurance policy
•
Elementary school record
•
Child’s birth certificate with age of member/parent
Position or Job Title/Department/Division or School: Your position or job title, the name of the Department and/or
Division you are employed with, and/or the name of the school where you work.
Employer: Check off whether you work for the State, County (identify which County), or Board of Water Supply.
Deposit Check To: Name of Financial Institution where you want your monthly pension checks to be deposited.
Specify whether it’s a checking account (attach voided check) or savings account (attach deposit slip), and provide the
account number. You will receive a monthly pension, which will be paid at the end of each month.
Daytime/Home/Cellular Phone:
Enter the appropriate number for each.
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