Ep-0646-0715ep-0646.qxd - newjersey-2025

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  1. Click ‘Get Form’ to open the document in the editor.
  2. Begin by filling out Section B with your personal information, including your name, Social Security number, and contact details.
  3. In Section C, select the type of rollover or transfer you are requesting. Ensure you check the appropriate box based on your retirement plan.
  4. If applicable, indicate whether you will be using personal funds alongside rollover funds and specify the amounts in Section C.
  5. Forward the completed form to your disbursing plan administrator for them to fill out Section D. Make sure they sign it.
  6. Once you receive the completed form back from your disbursing plan, submit it along with any checks to the Cash Receipts Section at the Division of Pensions and Benefits.

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