30-Day Waiting Period Waiver
Two Northside 75 Suite 100 Atlanta, GA 30318 (404) 352-6500 (800) 352-0650 fax (404) 352-4885 www.trsga.com
To Be Completed by Member-- please print clearly
_________________________________________ __________________________________ ___________
Last Name First Name Middle Initial
_________________________________________________________________________________________________
Mailing Address
(_________)___________________ ___________________________ __________ _____________________
Telephone Number City State Zip Code
I acknowledge that I have received information regarding my rights to have my taxable contributions and
interest rolled over to another eligible plan or IRA, or to have the taxable funds paid directly to me with the
appropriate taxes being withheld.
I wish to waive my right to a 30-day waiting period and have my funds paid as indicated on my Application for
Refund of Contributions.
___________________________________________________________ __________________________
Signature Date
Social Security Number
(11/16)
Teachers
Retirement
System of
Georgia
click to sign
signature
click to edit
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