Wuwludjoz kogil tuk vour P O Box 942715 Sacramento, CA 942292715 888 CalPERS (or 8882257377)Fax: (80 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Section 1, enter your first name, middle initial, and last name. Ensure accuracy as this information is crucial for identification.
3. Provide your Social Security Number or CalPERS ID in the designated field to facilitate processing.
4. Indicate the change you are requesting by selecting one of the options provided regarding your address.
5. In Section 2, fill in your correct mailing address. Remember that if you have health coverage through CalPERS, a P.O. Box cannot be used as your mailing address.
6. If applicable, provide additional details for foreign addresses including Province/Territory and Country along with the country code for telephone numbers.
7. In Section 3, ensure you sign and date the form. If you are a Guardian/Conservator or have Power of Attorney, include this acknowledgment.

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