Form Trs 6 - Application For Refund
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13Application for Refund
TRS 6 (09-17)
1000 Red River Street
Austin, TX 78701-2698
(800) 223-8778
Section 1 – Member Information
Name
Social Security Number
Address
Street Address or PO Box Number
City
State
Zip Code
Phone Number
Date of Birth
To be completed if your refund will be sent to a foreign address:
Are you a U.S. citizen?
Yes
No
If you are not a U.S. citizen, are you a resident alien of the U.S.?
Yes
No
If you answered no to both questions above, see page 2 of the Requesting a Refund Instructions (TRS6IN) for
additional information regarding required federal income tax withholding.
Section 2 – Refund Election (select one)
I elect to have my TRS accumulated contributions paid directly to me. I understand
that 20% of the taxable amount of my refund will be withheld for federal income taxes
(provided the amount is greater than $200.00). See page 2 of the Requesting a Refund
Refund
Instructions (TRS6IN) for information on tax withholding if you are a non-U.S. citizen
and a non-resident alien.
I elect to have all or a portion of my TRS accumulated contributions rolled over into an
eligible retirement plan. I understand that TRS will provide me with an additional form
Direct Rollover
if this option is selected. A Refund Rollover Election form (TRS6A) must be completed
and returned to TRS.
Section 3 – Payment Method for Portion Not Being Rolled Over
Direct
I elect to have the portion of my refund being paid directly to me sent electronically to the
Deposit
financial institution listed below.
Name of Financial Institution
_______________________________________
Account Type (must select one)
Checking
Savings
Bank Routing Number
Account Number
_______________________________________
The following declaration MUST be completed if you are requesting direct deposit.
Will this payment be transferred or forwarded outside of the United States?
If yes, to what
No
Yes
__________________________
country?
Percentage to be
_________________%
transferred
I elect to have the portion of my refund paid directly to me sent to my mailing address as
Check
a paper treasury warrant.
Be sure to include your name and Social Security Number on both pages.
Teacher Retirement System of Texas
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