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  1. Click ‘Get Form’ to open the document in the editor.
  2. Begin with Section A: Applicant Information. Fill in your first name, middle initial, last name, PERS number, and Social Security number clearly. Ensure all entries are legible to avoid delays.
  3. Move to Section B: Rollover Acceptance. As an authorized representative, select whether the plan will accept after-tax dollars by checking the appropriate box.
  4. In Section C: Rollover Account Information, provide the financial institution's name, rollover account number (if available), and specify the rollover plan type.
  5. Proceed to Section D: Rollover Mailing Address and Confirmation. Enter your address details including city, state, and zip code along with your name and title.
  6. Finally, complete Section E: Authorized Signature by signing and dating the form. If you are not the authorized representative, ensure that a plan administrator provides written confirmation.

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