Rollover request for service credit purchases - State of North Dakota - nd 2026

1. Click ‘Get Form’ to open it in the editor.
2. In Part A, provide your name, NDPERS Member ID, last four digits of your Social Security Number, date of birth, type of service credit, number of months of credit, and the maximum rollover/transfer amount.
3. Move to Part B. Here, indicate your request for NDPERS to accept your eligible rollover distribution/transfer. Select the type of account from which you are rolling over funds and enter the plan/provider company name along with the amount being transferred.
4. Sign and date the form in Part B. Ensure you include your telephone number for any follow-up communication.
5. If applicable, complete Part C by having the administrator of your eligible retirement plan or IRA custodian fill in their details and sign where required.
6. Finally, review all sections for accuracy before submitting the form along with your rollover/transfer funds to NDPERS.

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