Section 1
Information About You
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If you are an active CalPERS member, contact your personnel office and ask them to update your mailing address with us.
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If you are an inactive CalPERS member, update your address at my.calpers.ca.gov or call us toll free at 888 CalPERS
(or 888-225-7377).
Section 2
Your Retirement Information
Retirement Date - Your retirement date can be no earlier than your last day on payroll. If it has been more than nine months
since you left employment, the date you enter cannot be earlier than the first day of the month you submit this form.
Unused Sick Leave/Educational Leave - Your last employer must contract to provide this benefit, and you must retire within
120 days of leaving employment for any unused sick and/or educational leave to be included in your actual retirement benefit.
What is a survivor? - A survivor receives a monthly benefit regardless of the retirement payment you choose. We only
include this in your retirement estimate if your employer contracts to provide this benefit. A survivor is defined by law as:
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a spouse or registered domestic partner who was married or registered to you for at least one year before your service
retirement date and continuously until your death. (For disability or industrial disability retirement, these conditions
must be met on or before the effective date of your disability or industrial disability retirement.)
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natural or adopted unmarried children under age 18.
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an unmarried child who was disabled prior to age 18 and whose disability continues without interruption until
the disability ends or until marriage.
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qualifying financially dependent parents, if none of the above.
What is a beneficiary? - A beneficiary is any person you choose to receive either a one-time lump-sum payment
or ongoing monthly benefit upon your death.
Retirement Options - When you retire, you will choose one of the following retirement options and name a beneficiary.
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Unmodified Allowance - Provides the highest monthly allowance paid for life. There is no continuing monthly benefit
to a beneficiary and no return of unused member contributions upon your death.
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Return of Remaining Contributions Option 1 - Provides a lump-sum payout of any remaining member contributions
in your account to one or more beneficiaries upon your death.
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100 Percent Beneficiary Option 2 - Provides 100 percent of the option portion of your ongoing monthly benefit to your
named beneficiary upon your death. Upon both your deaths a lump-sum payout of any remaining member contributions
in your account will be paid to one or more named secondary beneficiaries.
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100 Percent Beneficiary Option 2 with Benefit Allowance Increase - Provides 100 percent of the option portion of
your monthly benefit to your named beneficiary upon your death. If your beneficiary dies before you, or if you have another
qualifying event, your benefit will increase to the Unmodified Allowance.
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50 Percent Beneficiary Option 3 - Provides 50 percent of the option portion of your ongoing monthly benefit to your
named beneficiary upon your death. Upon both your deaths, a lump-sum payout of any remaining member contributions
in your account will be paid to one or more named secondary beneficiaries.
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50 Percent Beneficiary Option 3 with Benefit Allowance Increase - Provides 50 percent of the option portion of your
ongoing monthly benefit to your named beneficiary upon your death. If your beneficiary dies before you, or you have
another qualifying event, your benefit will increase to the Unmodified Allowance.
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Flexible Beneficiary Option 4 - Provides an ongoing monthly benefit of a specific dollar amount or percentage of your
Unmodified Allowance to one or more named beneficiaries upon your death.
Section 3
Advanced Estimate Scenarios
Reciprocity
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Enter the name of the other California public retirement system you are a member of.
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Enter your highest average annual compensation for any consecutive 12- or 36-month period of employment
with the other retirement system.
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To be eligible for full reciprocal benefits, such as final compensation exchange, you must retire concurrently.
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Refer to the publication When You Change Retirement Systems (PUB 16) for detailed information.
Temporary Annuity
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This benefit is only available for a service retirement.
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Enter the amount you want to receive and to what age depending on your CalPERS membership date.
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If your membership is on or after January 1, 2002, your temporary annuity amount cannot exceed your estimated Social
Security benefit. This benefit is not free. Refer to the publication Temporary Annuity (PUB 13) for detailed information.
PERS-BSD-470 (11/19)
