Form F852 - Request For Information
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1F852
NYCERS USE ONLY
*852*
Mail completed form to:
30-30 47th Avenue, 10th Fl
Long Island City, NY 11101
Request for Information
Member Number
OR Pension Number
Last 4 Digits of SSN
Home Phone Number
Work Phone Number
(
)
(
)
First Name
M.I.
Last Name
Address
Apt. Number
City
State
Zip Code
Subject of Inquiry (for ex., loan, beneficiary)
Title
I would like NYCERS to supply me with the following information:
Signature
Date
R12/16
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Parent category: Business