I: Member Information
A member should indicate his or her
full legal name. Nicknames should not be used. If applicable,
please indicate member's maiden name in the space provided.
Line 2: Address
The employee should indicate the
current home mailing address.
Line 3: Social Security Number
The employee should enter the Social
Security number exactly as it appears on his or her Social Security
Line 4: Gender
Please check the appropriate box.
Line 5: Date of Birth
The member should enter the month,
day, and year of birth. A copy of a birth certificate, baptismal
certificate, or other acceptable form of proof
of age should be submitted at the same time this application
is filed. (Do not delay filing the application if the proof of
age is not available.)
Line 6a: Former Member of System
The employee should check "yes"
or "no". An enrollment application should not be filed
for any employee who is a former member and (1) did not terminate
by withdrawal or (2) has been inactive for less than two years.
If the employee checked "yes"
to 6a and the member's name has been changed, the Division of
Pensions and Benefits requires the member to enter the name under
which this previous membership was established.
The employee should enter the name
of any nonfederal public retirement system, in this or any other
state, in which the employee is or was a member. Private employment
should not be included in this section.
The employee should indicate if
he or she is receiving any retirement benefits at this time from
the public retirement system listed in 7a.
Part II: Certification of Employing
Agency - To Be Completed by the Employer
1a: Name of the Employer
List the complete name of the location.
Line 1b: County
List the county in which the location
Line 2a: Location No.
It is very important that this number
Line 2b: Bureau No.
For large locations, please include
the bureau number.
Line 2c: Payroll No.
For State agencies paid through Centralized
Payroll only, list the payroll number.
Payroll Title of Applicant
Please indicate the title under which
the employee was hired.
Line 4. Is this individual still
considered a temporary (provisional) employee?
This should be answered either "yes"
Line 5. Date Employment Began, Regular or Permanent Appointment Date
Note for Civil Service
Employers: If an employee is hired from a certified
Civil Service list, or is hired in an unclassified title, the
dates in Questions 6a and 6b would be the same.
Line 5a: Date employment
Indicate the employee's date of hire.
Line 5b: Regular or Permanent
This should be the date the employee
was given permanent status in his or her title or the first day
of the 13th consecutive month of employment.
Line 6: Date of Completion: Police, Firefighter, or Correction Officer Training
To be eligible for participation in PFRS, a position must meet the statutory definition of a “police officer” or “firefighter,” including the mandate that a candidate for a PFRS position must successfully complete specific training requirements.
All police officers enrolled in the PFRS must be certified in the basic training course for police officers, as prescribed by the Police Training Commission (PTC).
Correction officers enrolled in the PFRS must be certified in the basic training course for correction officers as prescribed by the Police Training Commission (PTC).
County investigators enrolled in the PFRS must be certified in the basic training course for county investigators as prescribed by the Police Training Commission (PTC).
Similarly, firefighters enrolled in the PFRS must complete and receive Firefighter 1 certification through the New Jersey Department of Community Affairs, Division of Fire Safety.
In Item 6, PFRS employers are to enter the date the prospective PFRS member completed the required training. Anyone seeking to become a police officer, correction officer, county investigator, or firefighter who does not successfully complete the PTC or Firefighter 1 certification will not be permitted to participate in the PFRS.
See the Training Requirements section of the PFRS Enrollments page of this manual if more information is required.
Line 6: Medical Requirement
Indicate the date medical requirements were approved by the examining physician; the medical exam must occur within one year of the submission.
It is no longer a requirement to attach the Report of Examining Physician to the enrollment application. However, the Report of Examining Physician must be kept on file at the employer’s location for auditing by the Division of Pensions and Benefits.
Line 8: Current base Annual
This should be the employee's contractual
base salary. Please do not give hourly or per diem rates.
Line 9. Required Signatures
The Certifying Officer and the Certifying Officer’s supervisor must sign and date this application. Unsigned applications will be returned. The signature by the Certifying Officer and the Certifying Officer’s supervisor must be an original signature, not stamped copies.
Before the Certifying Officer signs
the Enrollment Application, it is suggested that the application
be reviewed for missing, erroneous or inconsistent information.
A little effort at this juncture can prevent lengthy delays and
more work later.
Date of Enrollment
The employee must enroll as of the
regular or permanent appointment date. The employee has the option
to purchase all temporary service on a retroactive basis. Such
a purchase would require additional deductions.
Designation of Beneficiary Form To Be Completed by the Employee
There is no longer a Beneficiary Designation section on the PFRS Enrollment Application.
However, the employer should strongly encourage new employees to designate a beneficiary(ies) for pension and group benefits by either:
- Signing up for the Member Benefits Online System (MBOS), which will enable them to designate beneficiaries online by using the MBOS "Designation of Beneficiary" application, or;
- Completing a printed version of the Designation
of Beneficiary form correctly and completely and submitting it to the Division of Pensions and Benefits.
If the employee is using the printed version of the Designation
of Beneficiary form, please make
sure the employee has signed it before submitting.
If the member does not complete the online or printed Designation of Beneficiary form, the enrollment will be processed with the member's estate listed as both group
life insurance and pension beneficiary. In such cases, an insurance
packet and policy rider confirming the estate as beneficiary will
be mailed to the member.
Employers should submit the enrollment application as soon as possible, so that
the enrollment can be processed in a timely manner. Delayed
and forced enrollments can be costly to the employer.
In order to change the beneficiary
information in effect once enrollment has occurred, the member
must submit a separate Designation
of Beneficiary form.
A primary beneficiary is the person
(or persons) who will receive benefits at the time of a member's
A contingent beneficiary is the person
(or persons) who will receive the benefits at the time of the
member's death if the primary beneficiary has predeceased the
Rules for Designation of Beneficiaries
A member may nominate
any person, persons, institution, trust, estate, etc., as
primary or contingent beneficiary.
The same beneficiary(ies)
may be listed for both group life insurance and the return
of accumulated deductions or last check benefit. Using
the words, "Save as Above" is not acceptable; the
member must repeat the same information for both items.
If more than
one person is named as primary beneficiary, the following
shall apply: "Share and Share Alike, Survivor or Survivors."
If multiple beneficiaries are named, it is to be understood
that the beneficiaries living at the member's death will share
equally in the distribution of the death benefits, unless
otherwise indicated by the member. The same applies
to multiple contingent beneficiaries.
The Division of
Pensions and Benefits cannot require that the member provide
the beneficiary's Social Security number. Providing
the Social Security number of a beneficiary, however, may
expedite the processing of the death claim.
If additional space
is required, an attachment sheet is acceptable if the necessary
information is provided and it is signed by the member and
witnessed by a Notary Public (notarized).
When naming a married
female as beneficiary, be certain the proper name is given,
e.g, Mary J. Jones, not Mrs. John R. Jones. Nicknames
are also not acceptable.
- Definite dollar amounts should
not be indicated since the amount of group life insurance changes
with every change in the member's salary (for active members)
or retirement allowance (for retirees).
- The member may change
the beneficiary designation for the group life insurance,
accumulated pension deductions or last check benefit (retired
members) at any time.
- If no beneficiary designation
is in effect at the time of death, or the designation section
is incomplete or blank, payment will be made to the member's
a Beneficiary is a Minor
If a member wishes to name a minor
as a beneficiary for pension death and/or group life insurance
benefits, the manner of the designation can make a huge difference
in how benefits are paid.
- If a member dies leaving pension
death and/or group life insurance benefits to a minor, the Division
of Pensions and Benefits will withhold payment of the benefit
until one of the following occurs:
- A court ordered guardian of
the minor's property is appointed by the courts and
proof is forwarded to the Division, in which case the benefits
will be paid to the guardian on the minor's behalf; or
- The minor attains age 18.
- The member may choose to leave
pension death benefits and/or group life insurance benefits
to a trust established on behalf of a minor beneficiary. There
are two types of trusts, "formal" and "informal".
- A "formal trust" is established by formal, legal documents filed with a NJ
county court that establishes a person or persons or corporation
as "Trustee". When designating a formal trust
on behalf of a minor beneficiary, the member must clearly
state "Formal Trust" on behalf of the minor, include
the date of trust incorporation, and supply the name and
address of a trustee to contact upon the member's death.
All specified death benefits would then be paid to the trust.
- An "informal trust" is one that has not been filed with the courts and need
not be a formal agreement. In this case, the member designated
a person or persons to act as "informal trustee(s)"
on behalf of the minor. The informal trustee(s) would be
paid the specified benefits on behalf of the minor beneficiary.
Do's and Don'ts of Beneficiary
Based on frequent experience at the
Division, the following "Do's and Don'ts" are
suggested as a means to reduce the number of errors on beneficiary
designation forms and ensure that members are well served in this
Don't cross out names or use
"white-out" to make changes in designation. This makes
the form unacceptable: it will be rejected and a new form will
be mailed to the member.
Do complete a fresh form whenever
the member makes a mistake in designating a beneficiary. In the
long run, this will save the member time and will eliminate any
uncertainty regarding the desired designation.
Don't name the same person
or persons in both the Primary and Contingent Beneficiary sections.
This makes the form unacceptable: It will be rejected and a new
form will be mailed to the member.
Do choose both primary and
contingent beneficiaries with care.
Don't leave the address for
any beneficiary blank. This will require the Division of Pensions
and Benefits to generate a letter to request the required information.
Don't neglect the birthdate
of each beneficiary. This will require the Division of Pensions
and Benefits to generate a letter requesting the required information.
Don't forget to list the relationship
of each beneficiary to the member, or the Division of Pensions
and Benefits will be required to generate a letter requesting
the required information.
Do have all beneficiary information
on hand when completing a Designation of Beneficiary Form.