Employers' Pensions and Benefits Administration Manual (EPBAM)
   

 

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Teachers' Pension and Annuity Fund
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.

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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 an employee is already enrolled in the TPAF through other New Jersey public employment and is taking an additional TPAF-covered position at your employing location, then check the "Multiple Enrollment" box.

If the employee is already a TPAF member but is leaving a position at another employing location to assume a position at your employing location that is covered by the TPAF, then please check the "Report of Transfer" box.

Please note:

  • In the case of an employee with membership in another State-administered retirement (PERS, PFRS) who is leaving employment covered by that retirement system to take a position covered by the TPAF, please complete an Interfund Transfer Form, not a Report of Transfer/Multiple Employment Form, as well as the PERS/TPAF Enrollment Application.
  • In the case of an employee with membership in another State-administered retirement system (PERS, PFRS) who is taking employment covered by the TPAF in addition to the employment covered by the other State-administered retirement system, please use a PERS/TPAF Enrollment Application to enroll the employee in the TPAF. The employee will be a "dual member".

Retirement System

Indicate the employee's TPAF membership by checking the corresponding box.

Social Security Number

Please provide the employee'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. Include an extension if applicable.

Name of Former Employer

The new employer should provide the name of the former employer, or other employer if it is a multiple enrollment.

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 Name and Location/Payroll Number

The name and location/payroll number of member's new employing location must be provided.

Is New Employer a Board of Education?

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

Employee's Title—New Position

Please enter the employee's title in his/her new position.

Date Employment Began

Please provide employment start date for the new employee.

Does Position Require a New Jersey State Certificate?

Please check "yes" or "no" to indicate whether the position requires a New Jersey State Certificate issued by the State Board of Examiners within the NJ Department of Education.

Does the Applicant Hold a Certification?

Please check "yes" or "no" to indicate whether the applicant holds a certification issued by the State Board of Examiners within the NJ Department of Education.

Is the position Unclassified Professional?

Please check "yes" or "no" to indicate whether the position is Unclassified Professional (For NJ Department of Education Only).

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.

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 date, telephone number (with area code and extension), street address, city, county, state and zip, print out the completed form.

Then, the Certifying Officer of record 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 TPAF membership 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: August 8, 2007