Get Please Return This Application To The Retirement System In An Envelope Marked Personal And Con

Filling out the 'Please Return This Application To The Retirement System In An Envelope Marked Personal And Con' form is an important step for individuals seeking disability retirement benefits. This guide offers clear, step-by-step instructions to help users complete the form accurately and securely.

Follow the steps to complete the application accurately

1. Click 'Get Form' button to obtain the form and open it in your preferred editing tool.
2. Begin by entering your full name in the 'Name' field. Ensure correct spelling for accurate identification.
3. Select your sex by checking the appropriate box marked 'M' for male or 'F' for female.
4. Provide your complete address in the 'Address' section to ensure proper communication.
5. Enter your Social Security Number accurately in the corresponding field, keeping in mind the importance of confidentiality.
6. Fill in your registration number and date of birth as indicated. These details help in processing your application.
7. List your telephone numbers for work, home, and cell, ensuring each number is accurate and reachable.
8. Identify your employer and your payroll title within the designated fields.
9. State your length of service by specifying the years and months in the appropriate spaces.
10. Indicate your payroll status by checking 'Yes' or 'No', and provide an explanation if 'No' is selected.
11. Answer whether you have dual membership by selecting 'Yes' or 'No', depending on your membership status.
12. Describe your medical condition(s) that have led to your disability claim. If needed, use additional sheets.
13. List the doctors who have treated you along with their medical specialties and contact details.
14. Note any hospitalizations you have faced by including the hospital names and corresponding admission dates.
15. Respond to questions regarding incapacity due to accidents by selecting 'Yes' or 'No', and provide required details.
16. Document the witnesses to any accidents that occurred, including their names and addresses.
17. Fill out the information about your intended beneficiary, including their relationship to you and address.
18. Sign your name in the space provided and print your name beneath it to certify the truth of the information.
19. Finally, review all entries for accuracy, save changes, and prepare the form for submission by downloading or printing it.

Complete your application online today to ensure timely processing of your retirement benefits.