Summary of Forms and Documents Required
to Process Retirement Applications
COMPLETED FORMS REQUIRED
- Application for Retirement Benefits: Form CO-898 (Refer to Memorandum dated March 31,
1989, entitled "Retirement Applications".);
- Income Payment Election Form (Option): Form CO-899, CO-900, CO-901 or CO-902;
- Spouse Waiver of Monthly Survivor Benefits: Form CO-1047 Note: Do not let title of Form
confuse you - the CO-1047 must be executed for both married and single employees. (Refer
to memorandum dated January 25, 1990, entitled "Form for Spouse Waiver of Monthly
- Choice of Health Services after Retirement: Form CO-744 (Refer to memorandum dated May
7, 1997, entitled "1997 Health Insurance Open Enrollment Period".) Additionally,
copies of Medicare Part B cards for both the member and spouse should be provided, as
applicable, with the Form CO-744;
- Federal W-4P;
- State CT-W-4P (Refer to memorandum dated December 26, 1991, entitled "Withholding
of Connecticut State Income Tax".);
- Cost of Living Adjustment Election: Form CO-1100 (Refer to memorandum dated June 3,
1997, entitled "SEBAC V - Form for Cost of Living Adjustment Election".)
- Copy of member's birth certificate or acceptable substitutes with affidavit. Please
refer to Attachments "G" and "H" for further information.
- For married members, (a) copy of spouse's birth certificate or acceptable substitutes
with affidavit and (b) copy of marriage certificate.
- Where named contingent annuitant is other than a member's spouse, a copy of said
annuitant's birth certificate or acceptable substitutes with affidavit.
- For hazardous duty members, copy of roster cards reflecting all positions held in state
service which are required to meet twenty year threshold with cover letter listing
positions in chronological order. (Refer to Memorandum dated March 25, 1996, entitled
"Applications for Hazardous Duty Benefits from SERS).
- For members using accrued vacation time to meet the eligibility threshold, copies of
attendance records for 1997 reflecting leave balances that serve to bridge minimum service
If documentation is submitted under separate cover, the member's name, employee number,
and date of retirement should appear on each document.
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