Get Refund/rollover Request Form - Mass.gov

Filling out the Refund/Rollover Request Form is essential for users seeking to withdraw their accumulated pension deductions from the State Employees’ Retirement System. This guide provides clear, step-by-step instructions on how to complete the form accurately and efficiently online.

Follow the steps to fill out the form effectively.

1. Press the ‘Get Form’ button to access the Refund/Rollover Request Form. This will allow you to begin the process of filling out the necessary information.
2. Complete Section A by reading the instructions and filling in your member information. This includes your name, social security number, address, telephone number, and choosing either a refund or rollover request.
3. If you are requesting a rollover, proceed to Section B. Provide required details about your qualified retirement plan, including the type of plan, company name, and account number if available.
4. Ensure all information is printed clearly and correctly. If you are attaching a preprinted form from your Plan Administrator, check the appropriate box and include the document.
5. Review your form for accuracy. After confirming that all parts of the form are completed, save the changes and either download or print a copy for your records.
6. Finally, submit your completed form to your Payroll/Personnel department. They will handle the forwarding of the request to the State Board of Retirement for processing.

Start your Refund/Rollover Request Form online today to ensure a smooth withdrawal process.