Employers' Pensions and Benefits Administration Manual (EPBAM)



Information by Employer Task

Police and Firemen's Retirement System
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 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 the employee is already a PFRS member but is leaving a position at another employing location to assume a position at your employing location that is covered by the PFRS, then please check the "Report of Transfer" box.

In the case of PFRS members, the "Report of Transfer" check box is the only choice possible. PFRS eligible titles are full time positions, so multiple enrollments are not possible.

Retirement System

Indicate that the employee is a PFRS member 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.

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 Employer a Board of Education?

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

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.

Work Hours

Indicate whether the hours worked are fixed at 32 hours for local employees or 35 hours for State employees, in accordance with Chapter 1, P.L. 2010.

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 dates, telephone numbers (with area code and extension), street address, city, county, state, and zip, as requested, print out the completed form.

Then, the Certifying Officer of record and the Certifying Officer's supervisor 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 20, 2011