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Get PA PSRS-1248 2014

Otice of Election to Accept or Insurance Program PSERS Health Waive a Retirement Benefit PSRS-1248 (04/2014) Class T-C and Class T-D Members: I understand that I am eligible for a monthly benefit in addition to the withdrawal of my contributions and interest. Class T-E and Class T-F Members: I understand that I am eligible for a monthly benefit. I am electing to: (check one) File for a monthly retirement benefit. My Application For Retirement (PSRS-8) will be completed and forwarded to PSERS.

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