Location Number and Membership
The location number and the
membership number spaces in the box at the top of the
application are to be completed by the Division of Pensions and
Check the box indicating that the
employee is to become a member of the Teachers' Pension and Annuity Fund,
Part I: Applicant Information
Enter the employee's full legal name
(last, first, and middle initial). Nicknames should not be used.
If applicable, please indicate the member's maiden name or surname
used during a previous membership in the space provided.
Item 2: Address
Enter the employee's current
Item 3: Social Security Number
Enter the employee's Social Security
number (fill-in and print — numbers only).
Item 4: Gender
Please check the appropriate box
indicating the employee's gender.
5: Date of Birth
Enter the employee's month, day,
and year of birth, using the format mm/dd/yyyy. Since the employee's
proof of age is required at the
time of retirement, a copy of the employee's birth certificate,
baptismal certificate, or any other acceptable form of proof
of age should be submitted at the same time this application
is filed. (Please do not send the original.)
Do not delay filing the Enrollment
Application if the proof of age is not available.
6: Daytime Phone Number
Provide the applicant's daytime phone
number, with area code (and extension, if applicable).
7: Is member receiving retirement benefits from a New Jersey
State-administered or local New Jersey retirement system?
Check "Yes" or "No".
When checking "Yes", enter also the name of the New
Jersey State-administered retirement system or a local New Jersey
retirement system from which applicant is receiving retirement
There are many rules and laws governing
the return to public employment and reenrollment following retirement
from a NJ State-administered retirement system. For further
information, please see the "Employment
after Retirement" section provided in the Manual.
Part II: Employer Information
8: Name of the Employer
Please list the complete name of
the employing location.
For Boards of
Most school teachers
and staff are employees of the presiding board of education,
not the school in which they work. The board of education would
then be the "employing agency" and must be listed
as the employer on record, on the Enrollment Application,
rather than the name of the school.
Item 9: County
Please list the county in which the
employer is located.
Item 10: Location Number, Bureau
Number, and Payroll Number
Location Number: This is the
number assigned to your employing location by the Division of
Pensions and Benefits. The number you include on this line is
specific to the retirement system into which the employee will
be enrolled. It is very important that the Location Number be
Bureau Number: Please
include the Bureau Number if one has been assigned to your location.
Payroll Number: The Payroll
Number is required for State agencies paid through Centralized
The Location Number, Bureau Number
(if applicable), and Payroll Number (State locations paid through
Centralized Payroll only) should be entered as appearing on your
location's quarterly Report of Contributions (ROC).
Item 11: Title/Position of Applicant
Please indicate the title/position
under which the employee was hired.
12: Is applicant employed by more than one public employer?
Check "Yes" or "No".
If "Yes" is checked, please enter the full name of each
Items 13a-d: Item 13 information
is to be completed for TPAF applicants only.
Item 13a: Date Employment Began
Enter the date on which applicant
started employment. Do not include temporary or substitute service.
Item 13b: New Jersey Certificate
Indicate whether the employee's title/position
requires that the employee have New Jersey State Certification
issued by the State Board of Examiners within the NJ Department
Item 13c: Applicant Has New Jersey
Indicate whether the applicant holds
a New Jersey Certificate issued by the State Board of Examiners
within the NJ Department of Education.
Item 13d: Unclassified Professional
For positions with the NJ Department
of Education, indicate if the position is
Item 14-17 information
is to be completed for PERS applicants only. Skip if applicant
is enrolling in the TPAF.
Items 14a-b: Enter date employment began and date of regular or permanent appointment.
Item 14c: Indicate if the applicant is considered temporary or provisional.
Item 15: Indicate if the applicant is considered temporary or provisional.
Item 16: Current Base Annual Salary
Be sure to use the current annual
base salary only. Do not insert hourly or per diem rates. For
hourly employees, use the best estimate of current annual base
Base salary is the contractual salary
of the employee. Base salary should not include bonuses, overtime
pay, stipends or longevity pay, or sick or vacation time paid
as a lump sum.
The Division of Pensions and Benefits
cannot enter hourly or per diem rates. Base salary must be entered
as an annual figure.
Item 17: Ten-month or Twelve-month
Indicate if the employee is employed
on a ten- or twelve-month per year basis.
Part III: Employer Certification
18: Name of Human Resources Representative Completing Application
Please list the name of the human
resources representative completing the application.
Item 19: Phone Number and Extension
of HR Representative
Please enter the phone number (with
area code) and extension of the human resources representative
entered in Item 18 who is completing the application.
Item 20: Certifying Officer's
Name, Signature and Date
Please enter the Certifying Officer's
name and today's date, using the format mm/dd/yyyy. After printing
the completed form, the Certifying Officer must also sign the
Enrollment Application in the space provided.
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.
The signature by the Certifying Officer
must be an original signature, not a stamped copy.
Obtaining Veteran Status for
Please direct all PERS and TPAF
members who wish to obtain veteran status for PENSION PURPOSES, to submit a copy of their military
discharge (DD-214) to the NJ Department of Military and Veteran
Affairs, as outlined below.
Effective March 1, 2001, State
law (Chapter 127, P.L. 2000) made the New Jersey Department
of Military and Veterans Affairs (NJDMAVA) responsible for determining
veteran status for both pension purposes and for Civil Service
preference. Therefore, a copy of the military discharge, or
DD-214, should no longer be sent to the Division of Pensions
and Benefits. It should be sent, instead, to the NJDMAVA at
the following address:
NJ Department of Military
and Veteran Affairs
PO Box 340
Trenton, NJ 08625-0340
Since people apply for veteran
status for both pension purposes and for Civil Service preference, a note should be attached to the discharge, giving the employee's
address and indicating that the discharge is being sent to obtain
veteran status in the retirement system.
If you or the employee have questions
about veteran status, you can call the NJDMAVA at 1-800-624-0508,
or check their Web site at http://www.state.nj.us/military/veterans/status.html
Form DD-214 may be submitted
at any time during a member's career. Please do not delay in
submitting the Enrollment Application if the DD-214 is not available. However, waiting until the time of retirement
to establish veteran status for pension purposes could delay
the retirement process for the member.
In order to process a veteran enrollment,
both the front and reverse sides of the discharge, establishing
induction and discharge dates, must be furnished. If the member
does not have a copy of Form DD-214, a copy can
be obtained through written request to:
Military Personnel Records
9700 Page Boulevard
St. Louis, MO 63132
If an employee does
not qualify for veteran status for pension purposes, a letter
will be sent notifying the member of the decision. The member
will be enrolled as a non-veteran.
Designation of Beneficiary Form
There is no longer a section for beneficiary designation on the PERS/TPAF Enrollment Application. The member must first register with the Member Benefits Online System (MBOS) to nominate a beneficiary or beneficiaries for his or her group life insurance and/or pension benefit.use the online "Designation of Beneficiary" application, available through MBOS, or the printed version of the Designation of Beneficiary form
to nominate a beneficiary, or beneficiaries, for his or her group
life insurance and/or pension benefit.
Employers should strongly recommend that new employees complete the online "Designation of Beneficiary" application through MBOS in a timely manner (see below).
To designate or update beneficiary information using the online "Designation of Beneficiary" application, members must first register with the Member Benefits Online System (MBOS).
Fact Sheet #68, Designating a Beneficiary, is available to provide information to members requiring help in making their beneficiary selections for pension and/or group life insurance. Some information about selecting beneficiaries is also provided below.
Members wishing to sign up for MBOS at this time should be directed to the "MBOS Registration Information" page, at: http://www.state.nj.us/treasury/pensions/mbosregister.htm
If a member does not designate a beneficiary, the member's
estate will be listed as both the 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.
To change the beneficiary
information in effect once enrollment has occurred, the member
must update his or her beneficiary information online using the MBOS Designation of Beneficiary application.
Benefits for Which
a Beneficiary Is Named
Group Life Insurance: All
employees enrolled in the TPAF will be be entitled to group life
insurance coverage. Members who are age 60 or older at the time
enrollment must prove insurability through a medical examination
administered by the Prudential Insurance Company.
Return of Member Contributions:
The pension benefit is the return of the member's contributions
to the TPAF, paid in a lump sum to the member's designated beneficiary(ies)
upon the member's death.
information regarding group life insurance for employees enrolled
in the TPAF is available through this link.
Insurance and Pension Benefit Choosing Beneficiaries
A primary beneficiary is the person
(or persons) who will receive benefits at the time of an employee's
The member should provide each primary
beneficiary's full name, current address, relationship to member,
and birth date.
A contingent beneficiary is the
person (or persons) who will receive the benefits at the time
of the employee's death only if all of the primary beneficiaries
have predeceased the employee.
The member should provide each contingent
beneficiary's full name, current address, relationship to member,
and birth date. Providing each beneficiary's Social Security number
is not mandatory, but can expedite processing of the death claim.
Rules for Designation of Beneficiaries
- A member may nominate any person,
persons, institution, charity, corporation, trust, your estate,
etc., as primary or contingent beneficiary.
- 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.
The same applies to multiple contingent beneficiaries.
- Nicknames are not acceptable--use
the beneficiary's full name. When naming a married female as
beneficiary, be certain the proper name is given, e.g., Mary
J. Jones, not Mrs. John R. Jones.
- 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
- If the member has special provisions when nominating a beneficiary (i.e., names a trust), a paper version of the Active Member Designation of Beneficiary form must be completed. To obtain a copy of the form, contact the Division for more information.
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 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".
- The minor attains age 18.
- 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 designates
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.
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
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 requesting the required information.
Don't neglect the birth date
of each beneficiary. This will require the Division of Pensions
and Benefits to generate a letter to request the required information.
forget to list the relationship of each beneficiary to the member.
This will require the Division of Pensions and Benefits to generate
a letter to request the required information.
Updating Beneficiary Designation
It is very important for members
to review beneficiary information periodically, especially when
major life events occur, and update this information when necessary.
Members wishing to change their named beneficiary(ies) must
use the online MBOS "Designation of Beneficiary" application.