Employers' Pensions and Benefits Administration Manual (EPBAM)
Winter 2003



Information by Employer Task


Public Employee's Retirement System
Report of Transfer/Multiple Enrollment Form

Click here to view the fill-in and print
Report of Transfer/Multiple Enrollment Form.

The Report of Transfer/Multiple Enrollment Form will open in a separate window, enabling you to follow the item-by-item Report of Transfer/Multiple Enrollment Form instructions below to guide you while you complete the application.*

The Report of Transfer/Multiple Enrollment Form above is in a fill-in and print format:

  • Use your keyboard to type in the information requested for each item.
  • Use your tab button to advance to the next item.
  • Then, print the completed form from your printer.
  • Sign the "Signature of Certifying Officer" portion of the form.
  • Mail the form to: Enrollment Section, New Jersey Division of Pensions and Benefits, PO Box 295, Trenton, NJ 08625-0295.

Back to PERS Enrollment Guide

Back to Enrollments Procedures Guide Main Page

Directions for Completion of the
Report of Transfer/Multiple Enrollment Form

Report of Transfer and Multiple Enrollment Check Boxes—Type of Action

Check the box that corresponds to the task you wish to accomplish.

If an employee is already enrolled in the PERS through other New Jersey public employment and is taking an additional PERS-covered position at your employing location, then check the "Multiple Enrollment" box.

If the employee is already a PERS member but is leaving a position at another employing location to assume a position at your employing location that is covered by the PERS, then please check the "Report of Transfer" box.

Retirement System

Indicate the employee's PERS membership by checking the corresponding box.

Social Security Number

Please provide the member's Social Security number.

Pension Membership Number

Enter the employee's membership number.

Member Address

Provide the member's address (street, city, state, zip code).

Daytime Telephone Number

Enter the member's daytime telephone number, with area code.

Name of Former Employer

The new employer should provide the name of the former employer, or other employer if it is a multiple enrollment.

Date of Last Pension Deduction Reported by Former Employer

The new employer should obtain the date of last deduction by calling the old employer for the last date deductions were taken from the member's pay.  The information can usually be obtained with a phone call.

New Employer Location/Payroll Number

The member's new employing location must provide its location number/payroll number.

Is New Employing Location a Board of Education?

Please check "yes" or "no" to indicate whether the new employing location is a board of education.

Employee's Title—New Position

Please enter the employee's title in his/her new position.

Hire Date

Please provide employee's date of hire.

Current Annual Base Salary

Give the member's current annual contractual base salary.

Employee Paid on Ten- or Twelve Month Basis

Indicate whether the member is paid on a ten-month or twelve-month basis.

Is Employee Employed by More Than One Public Agency?

Indicate if the member is employed at more than one public agency. If yes, please list public agencies where employed.

Signature of Certifying Officer, Date, Telephone Number, Address

After entering the date, telephone number (with area code and extension), street address, city, county, state and zip, print out the completed form.

Then, the Certifying Officer of record must sign the completed form in the space provided. Mail the completed form to: New Jersey Division of Pensions and Benefits, PO Box 295, Trenton, NJ 08625-0295.

The Report of Transfer/Multiple Enrollment Form should be filed with the Division of Pensions and Benefits within 10 working days of the date employment begins. The employer should establish that the employee’s membership in the retirement system has not expired or been withdrawn. If the employee’s membership has expired or been withdrawn, the employee must complete a new enrollment application. The Division of Pensions and Benefits will process the Report of Transfer/Multiple Enrollment Form and will send a Certification of Payroll Deductions to the new employer advising the employer of the date pension deductions must begin for the transferring employee.















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Last Updated: September 13, 2004