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Get CA UBEN 106 2015

LECTION FOR UNIVERSITY OF CALIFORNIA RETIREMENT PLAN (UCRP) INCOME UBEN 106 (R9/15) University of California Human Resources Send to: UC RASC Retirement Administration P.O. Box 24570 Oakland CA 94623-1570 1. PERSONAL INFORMATION NAME (Last, First, Middle Initial) SOCIAL SECURITY NUMBER MAILING ADDRESS (Number, Street, City, State, ZIP, Country) DAYTIME PHONE ( Status: (check one) ) UCRP Member Survivor or Contingent Annuitant Former Spouse PERS Plus 5 Member PERS Plus 5 Surv.

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