Fillable Retirement Application Instructions (Clovis Community College)

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Retirement Application Instructions (Clovis Community College)

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Retirement Application Instructions
Return completed forms to: PO Box 26129 Santa Fe, NM 87502-0129 1(866) 691-2345
Member Information
Include your work and home telephone numbers so we can contact you if we have questions. List your most
recent NMERB employer even if you have been in an inactive status and indicate if you have had previous
employment with city, county or state government under the New Mexico Public Employees Retirement
Association (PERA). If you wish to receive the quarterly ERB newsletter and other updates via email, please
enter your email address in the space provided.
The beneficiary information must be completed if you wish an estimate based on the optional forms of payment. You
will make a final, irrevocable beneficiary determination when you receive your final retirement documents.
Inactive members only need to complete page 1 of the application.
Verification of Date of Birth
Verification of the member’s date of birth must accompany the retirement application. This verification may be a copy
of one of the following documents: birth certificate, delayed birth certificate, baptismal certificate, passport,
driver's license, certificate of Degree of Indian or Alaskan Native Blood (CDIB). If you are requesting Option B and
Option C calculations you must also include verification of date of birth for your beneficiary.
Effective Date of Retirement
The effective date of retirement of members completing the academic school year is July 1; otherwise, the
effective date of retirement may be the first day of the month following termination of employment or following receipt
of the retirement application by the ERB, whichever is later.
The original application should be filed 60 to 90 days prior to the effective date of retirement. Faxed applications are
not accepted.
Optional Forms of Benefit Payment
There are three optional forms of benefit payment; Option A, Option B, and Option C.
If the member selects Option A, there is no reduction to the monthly benefit and there is no continuing benefit due
a beneficiary or estate, except the balance, if any, of the contributions less benefits paid. The retirement benefit
ceases upon the member's death.
•
If the member selects Option B, the monthly benefit is reduced to provide for a 100% survivor benefit. The IRS
prohibits the selection of Option B for a non-spouse beneficiary more than 10 years younger than the member.
 If the member selects Option C, the monthly benefit is reduced to provide for a 50% survivor benefit.
The benefit reduction with an Option B or C form of payment is based on the age of the member and the age of the
beneficiary at the time of retirement. The decision is made in the Final Selection of Benefit form, which will be
included in your retirement documents packet.
Monthly Benefit Payments
For your convenience, the NMERB will electronically transfer your retirement benefit into your bank account or other
financial institution. This method has proven to be a safe and fast way of conducting this type of financial transaction.
Please note that your first benefit payment will be electronically sent to your selected financial institution
on the last business day of each month.
If the applicant is employed at the time the application is filed, the initial benefit payment will be an estimate based on
the salary information provided by the your employer before the final payment has been made to the member. After
final salary information has been reported to the NMERB, the benefit will be recalculated and retroactively adjusted if
necessary.
Community Property and Retirement Benefits
The retired member is not subject to execution, levy, attachment, garnishment, or other legal process, except that any
portion awarded to a former spouse in a court decree is paid directly to the former spouse when directed by the courts.
Revised: 10/2018
Santa Fe Office: 701 Camino de los Marquez, Santa Fe, NM 87505 | Albuquerque Office: 8500 Blvd. NE Suite B-450, Alb., NM 87112
Return completed forms to: PO Box 26129 Santa Fe, NM 87502-0129 1(866) 691-2345
Application For Retirement—Checklist
In order to prevent a delay in processing your retirement, please check your application for any
missing or incomplete information. Missing information will require that the application be
returned to your employer. Use this checklist to confirm that all information is provided.
Section I: Member and Beneficiary Information
Member Information
 member name
 member address, city, state, zip, email
 member gender
 member’s effective date of retirement
 date of application
 member SSN
 member date of birth
 member last employer
 member home telephone number
 signature of member

Copy of either birth certificate, baptismal
record, passport, or Driver's License.
Beneficiary Information
(ONLY if requesting information about
Option B and C forms of payment)
 Beneficiary name
 Beneficiary date of birth
 Beneficiary relationship
 Beneficiary SSN
 Beneficiary gender

Copy of either birth certificate, baptismal re-
cord, passport, or Driver's License.
 last date of employment
 signature of authorized official
 title of authorized official

estimated final wages (must include all summer pay)
 employer name
 date signed
Section II: Employer Information
Santa Fe Office: 701 Camino de los Marquez, Santa Fe, NM 87505 | Albuquerque Office: 8500 Menaul Blvd. NE Suite B-450 Alb., NM 87112
Return completed forms to: PO Box 26129 Santa Fe, NM 87502-0129 1(866) 691-2345
Application For Retirement—Member Completion page 1 of 2
The NM Educational Retirement Board will provide you with a calculation of your retirement benefit under
Options A, B, or C forms of payment. Please see below the descriptions of the optional forms of payment.
If you are interested in Options B or C please complete the following information along with proof of
beneficiary’s age. If you are not interested in Options B or C calculations, please leave this section blank.
You will provide beneficiary information with your Final Selection of Benefit form which NMERB will send
you. The IRS prohibits the selection of Option B for a non-spouse beneficiary more than 10 years younger
than the member.
Beneficiary Name: _________________________________ Beneficiary SSN: ________________________
Beneficiary Date of Birth: _____
_________
_____ Male Female Relation: ______________________
I hereby apply for retirement as provided by the New Mexico Educational Retirement Act to become
effective ________________________________. I understand that if I am employed by more than one
NMERB employer I must submit a separate application from each employer.
Signature: __________
__________________________ Date: ________________________
Optional Forms of Payment
Option A
This option provides you with the
largest monthly sum upon
retirement.
The benefit ends upon the
member’s death.
A beneficiary will only receive any
balance left of the member’s
contributions plus interest.
Option B
The member’s benefit is reduced.
Your beneficiary receives the
same benefit amount upon your
death.
The member will receive payment
Option A if the beneficiary
pre-deceases the member.
Option C
The member’s benefit is reduced,
but by a lesser amount than
Option B.
Your beneficiary receives half of
the benefit amount upon your
death.
The member will receive payment
Option A if the beneficiary pre-
deceases the member.
Revised 10/2018
Section I: Member Information (To be completed by the member)
Name: __________________________________________ Active Employee Inactive Employee
Address: _______________________________________________________________________________________
City State Zip
Social Security Number: ______________________ Male Female Marital Status: _________________
Date of Birth: _______________________________ Contact: ___________________ ___________________
(Proof of age must accompany this application) home/cell number work number
Most recent employer covered under NMERB: ________________________________________________________
Do you have PERA Service? (city, county and/or state government in NM) Yes No
(Optional) I wish to receive the ERB newsletter and other updates at my personal email address below:
Personal email address
Section II: Employer Certification
Member’s last date of employment: _____________________ Position Held: _________________________
Was this employment for 218 days or more per academic year? Yes No
 Nine month employees completing the academic year must have an effective retirement date of July 1.
 Members who are employed 218 or more days in an academic year may retire the first day of the month
following termination or following ERB’s receipt of the retirement application, whichever is later.
All estimated salaries applicable to the member’s final calendar quarter of employment must be reported.
Payments made for unused sick leave, unused annual leave, or early retirement incentives are not reported
for retirement purposes.
Please report estimated salaries paid in the last two quarters
of the member’s employment.
September $________________________ March $ ________________________
December $ ________________________ June $ _________________________
Contact Person: ____________________________ Telephone Number: __________________________
I hereby certify to the New Mexico Educational Retirement Board that the information provided in
Section II is accurate.
_______________________________________ __________________________________________
Employer Signature of Authorized Official
_______________________________________ __________________________________________
Date Title of Authorized Official
If the member’s application is received after the effective date desired by the member, the NMERB may only
change the effective date if the delay in filing was due to a delay in processing by the employer and not due to
the fault of member. A written statement from the employer to the NMERB director is required.
Mail the completed application to the mailing address below:
New Mexico Educational Retirement Board
PO Box 26129
Santa Fe, NM 87502-0129
toll free: 1-866-691-2345
phone: 505-827-8030
website: www.nmerb.org
Employer Certification
(For active members only)
For: SSN:
page 2 of 2
Receipt/Postmark Date:
(To be completed by the employer only if member is in an active status)
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Retirement Application Instructions (Clovis Community College)

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Completed 20 September 2020

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