Address Change Form
PART A. MEMBER INFORMATION
Member Name
Social Security #
Phone Number
Email Address
STEP 1
Please fill out your form,
typed or printed in ink,
and remember to sign.
If this is a RRS ONLY update,
consider making this change
online using RAPIDS Retiree
Self Service.
STEP 2
Submit your form...
STEP 3
...during our walk-in hours,
Monday thru Friday,
10AM-12PM and 1PM-3P,
with a photo ID
or
...by mailing your form to:
Richmond Retirement System
730 E. Broad Street, Suite 900
Richmond, VA 23219
THANK YOU!
PART B. ADDRESS
PART D. TYPE OF UPDATE
I hereby authorize the RRS to change my address.
Signature Date
This form is for retirees or former
employees who would like to update
their address.
Current employees can log in to
RAPIDS Employee Self Service or
contact the Department of Human
Resources.
DIRECTIONS
Richmond Retirement System | 730 E. Broad Street, Suite 900, Richmond, Virginia, 23219 | Tel: (804) 646 - 5958 | Fax: (804) 646-5299 | www.richmondgov.com/retirement
I am a Power of Attorney or guardian, and documentation is attached
I am the member
Forms are processed the 15th
of each month.
OLD ADDRESS: NEW ADDRESS:
PART C. CITY / COUNTY FOR NEW ADDRESS
City of Richmond, Virginia
Chesterfield County, Virginia
Henrico County, Virginia
Other:
EFFECTIVE DATE FOR ALL CHANGES:
RRS ONLY
RRS + CIGNA
PART E. CERTIFICATION
RRS USE ONLY
Date Processed: __________________
Reviewed By: __________________
ID Verified:
___________________________________
Form revised November 2017
