Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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Police and Firemen's Retirement System
Enrollment Application
 


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Back to PFRS Enrollments Guide


Part I: Member Information

Line 1:   Name 

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 card.

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.

Line 6b.  

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.

Line 7a. 

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.

Line 7b.  

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

Line 1a: Name of the Employer

List the complete name of the location.

Line 1b: County

List the county in which the location is found.

Line 2a: Location No.

It is very important that this number be included.

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.

Line 3. 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" or "no".

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 began

Indicate the employee's date of hire.

Line 5b: Regular or Permanent Appointment Date

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 Salary

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.

Primary Beneficiary

A primary beneficiary is the person (or persons) who will receive benefits at the time of a member's death.

Contingent Beneficiary

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 member.

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 estate.

When 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.

  1. 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.
  2. 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 Designation:

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 important area.

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.

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Last Updated: September 19, 2011