Change Of Information Form
General Employees’ Retirement Fund, 306 E. Jackson Street, 7E, Tampa, FL 33602 • (813) 274-7850 • Fax: (813) 274-7289
Email
Name
Effective date for changes
NEW ADDRESS:
NEW PHONE NUMBER:
NEW EMAIL:
I am the member
I am a Power of Attorney or guardian, and documentation is attached
DIRECTIONS
This form is for
retirees
or
former
employees
who would
like
to
change their
information.
Current employees can log
in
to
ORACLE
Employee Self
Service
or
contact
the
Department
of
Human
Resources.
STEP 1
Please
complete form
by
typ
ing or
printing
in
ink. Please
remember
to
sign.
STEP 2
____________________________
Signature
_____________________________
Date
REV. 1/20
PART A. MEMBER INFORMATION
Check Changes: Address Phone
Name:
PART B. ADDRESS CHANGE
PREVIOUS ADDRESS:
Last 4 of
social security:
Pension ID:
PART C. PHONE AND EMAIL
PREVIOUS PHONE NUMBER:
ADDITIONAL NUMBER(S):
PREVIOUS EMAIL:
PART D. NAME CHANGE (Must provide drivers license, social security card, or marriage license)
PREVIOUS NAME:
NEW NAME:
PART E. CERTIFICATION
I hereby authorize the General Employees’ Retirement Fund to update my information as provided
above.
Submit
your form:
A) During business hours:
Monday – Friday
8:00 AM – 4:00 PM,
With a photo ID
B) By faxing to:
813-274-7289
C) By mailing to: General
Employees’
Retirement Fund 306 E
Jackson St, 7E Tampa
FL 33602
STEP 3
Forms
are
processed
during
mid month. Any forms
received after processing,
will be held and processed
for the following month.
You may call us for deadline
updates: 813-274-7850
THANK YOU!
OFFICE USE ONLY
Date Received:____________
Received By:______________
ID Verified:________________
Date Scanned:_____________
OFFICE USE ONLY
Processed By:_____________________ Checked By:____________________ Date Complete:_________________
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