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Form 100, Enrollment Form: Member Information Record


State: Alabama
Category: Retirement
Format: PDF
Form Name: ERS 100 Enrollment Member Info Record.pdf
(The pdf reader is necessary.)
Form Instructions:

 

INSTRUCTIONS: ALABAMA ERS ENROLLMENT MEMBER INFORMATION RECORD (Form ERS 100)

 

 

To enroll in the Employees' Retirement System of Alabama, you should file a form ERS 100. This document can be obtained on the website of the Retirement Systems of Alabama.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 1: Indicate with a check mark whether you are filing as a new member or are transferring from another ERS agency.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 2: Enter your full name.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 3: Enter your Social Security number. 

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 4: Indicate your gender and filing status with check marks.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 5: Enter your date of birth.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 6: Enter your full address.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 7: If applicable, enter the name and date of birth of your spouse.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 8: Enter the classification or title or elected office you hold.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 9: Enter the name of your employing agency and the section or division.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 10: Answer the next five questions by checking "Yes" or "No" as appropriate.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 11: If you answered any of the last four question "Yes," you must complete the table below. List your three most jobs. Enter the employing agency in the first column, the city in the second column, the year in the third column, the name under which you worked in the fourth column, and the date on which your employment was terminated in the fifth column.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 12: Sign and date the form.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 13: The second page requires you to designate a primary and contingent beneficiary to be paid your total accumulated contributions to the retirement system in the event of your death.

 

Alabama ERS Enrollment Member Information Record ERS 100 Step 14: Sign and date the second page in the presence of a notary public.

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