Waiver of “65/40” Mandatory Requirements
TR-54 (0505)
As provided for in Section 47-3-41 of Georgia Law, I hereby elect to continue contributing to the Teachers
Retirement System of Georgia (TRS). As a result of this waiver, I agree to allow employee contributions to
be withheld from my salary by my employer.
I understand that this waiver may be revoked only at the expiration of a school or contract year and then
only upon written application by me through my employer to the Board of Trustees of the TRS. I further
understand that no additional credit for years of service for retirement benets will accrue to my account
beyond a total of forty (40) years and that retirement credit for salary only will be given for those years over
forty (40) for which I have made the necessary contributions.
With the approval of this waiver, and if applicable, I agree to pay retroactive contributions and interest for
each year preceding the effective date of this waiver that I was an active member and during which time I
did not make contributions. I further understand that any contributions that I have made or will make as a
result of this waiver are not subject to refund should I revoke this waiver at a later date unless I withdraw
my total contributions and interest in lieu of accepting retirement benets.
To Be Completed by Member -- please print clearly
_________________________________ __________________________ ___________________
Last Name
First Name Middle Initial
_________________________________________________
______________________________
Member’s Signature Date
To Be Completed by Employer -- please print clearly
I hereby acknowledge receipt of this waiver and agree to withhold and report the necessary contributions
relating to this member’s salary to TRS.
___________________________________________________________________________________
Reporting Employer’s Name
_________________________________________________
______________________________
Approving Authority’s Signature Date
_________________________________________________
_____________________________
Authority’s Printed Name Title
Social Security Number
*TRS-WC-1*
Teachers
Retirement
System of
Georgia
Two Northside 75 Suite 100 Atlanta, GA 30318 (404) 352-6500 (800) 352-0650 fax (404) 352-4885 www.trsga.com
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