• Your Full Name*
• Job Title*
• Employer*
• Are You an ERS or PFRS Member?*
  ERS PFRS NYSTRS
• What Tier Are You In?*
  Tier 1 Tier 2 Tier 3 Tier 4 Tier 5 Tier 6
• Your Date of Birth*
   / Month  / Day Year

  Date
• Beneficiary's Date of Birth*
   / Month  / Day Year

  Date
• Projected Retirement Age*
• Total Years of Pension Creditable Service at Retirement*
• Should be Empty: