The Application for Withdrawal of Total Accumulated Deductions allows an eligible member to
receive a refund of the total accumulated deductions in his or her annuity savings (retirement)
account. An eligible member is one who:
has terminated his or her employment with a governmental unit;
is not receiving workers’ compensation;
is not seeking to be restored to his or her position; and
is not accepting a position in the service of the Commonwealth or one of
its political subdivisions.
Members are strongly advised to review the following:
If you have over ten years of creditable service, you may currently be or
might become eligible for a retirement allowance. By taking a withdrawal
of your accumulated total deductions, you will lose any right to this
retirement allowance. Before proceeding with a withdrawal, you should
ask your retirement board for a personalized estimate of any benefits that
you will forego by withdrawing.
Taking a refund of your total accumulated deductions terminates your
rights in the retirement system and may subject you to tax consequences.
For distributions made after January 1, 2002, please be aware that your
options of an eligible retirement plan for transferring your deductions have
been expanded dramatically. Please carefully review the “Special Tax
Notice” that accompanies this application. If you have unresolved
concerns, you may wish to consult with an attorney or a tax professional.
The amount of interest that members receive will vary, depending upon the years of
creditable service and the nature of the separation from employment.
Your employer must certify the termination of your employment, that you owe no
obligation to the employer under an employee benefit plan, and sign this application.
Your retirement board will determine if you are eligible for a refund of your
total accumulated deductions.
Members must complete pages 1, 2, and 3, and sign page 3.
Application for Withdrawal of Accumulated Total Deductions
Form Last Revised: ,WPG
COMMONWEALTH OF MASSACHUSETTS | PUBLIC EMPLOYEE RETIREMENT ADMINISTRATION COMMISSION
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