Trs Form Rw41 – Fill Out and Use This PDF

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TDA PARTICIPANTS

•฀฀฀If฀you฀file฀this฀form฀and฀are฀a฀participant฀in฀TRS’฀Tax-Deferred฀Annuity฀(TDA)฀Program,฀you฀must฀also฀withdraw฀

your TDA funds at this time by filing a “TDA Withdrawal Application” (code TD32). You may elect that TRS effect a Direct Rollover of your TDA withdrawal by filing a “TDA Direct Rollover Election Form” (code TD22) with your withdrawal application.

Note: As a result of Internal Revenue Service (IRS) regulations governing Section 403(b) Plans, TDA participants

are currently not permitted to move funds from TRS’ TDA Program to a Section 403(b) Plan outside of New York City. On the advice of outside tax counsel, TRS has suspended all processing of requests to move TDA funds to a Section 403(b) Plan (except the New York City Board of Education Retirement System) pending further clarification from the IRS.

CANCELLATION OF THIS APPLICATION

•฀฀฀This฀form฀may฀be฀canceled฀if฀you฀file฀a฀“Request฀for฀Withdrawal฀of฀Form/Application”฀(code฀MI5)฀with฀TRS฀within฀ 30฀days฀of฀filing฀this฀application.฀฀You฀may฀subsequently฀file฀a฀new฀“Application฀for฀Withdrawal฀of฀QPP฀ Accumulations”;฀TRS฀would฀implement฀the฀elections฀that฀are฀indicated฀on฀your฀most฀recent฀form฀on฀file.

PROCESSING OF THIS APPLICATION

•฀฀฀Processing฀of฀your฀QPP฀withdrawal฀should฀be฀completed฀within฀four฀months฀of฀TRS’฀receipt฀of฀all฀completed฀forms฀ and฀required฀documentation.

For฀your฀convenience,฀TRS฀forms฀and฀publications฀are฀available฀on฀our฀website.฀If฀you฀require฀additional฀assistance,฀ we฀encourage฀you฀to฀contact฀our฀Member฀Services฀Center฀at฀1฀(888)฀8-NYC-TRS.

In฀Part฀A:฀฀All information must be provided.

In฀Part฀B: You must elect how your withdrawal will be distributed.

You may elect to receive your withdrawal through one of the following methods or a combination:

•฀฀฀Direct฀Withdrawal,฀in฀which฀the฀withdrawal฀would฀be฀made฀payable฀directly฀to฀you.

•฀฀฀Direct฀Rollover,฀in฀which฀all฀or฀part฀of฀the฀taxable฀portion฀of฀your฀withdrawal฀would฀be฀made฀payable฀directly฀to฀an฀eligible฀IRA(s)฀

or other successor programs.

You฀may฀be฀eligible฀to฀receive฀your฀Direct฀Withdrawal฀via฀Electronic฀Fund฀Transfer฀(EFT)฀if฀you฀are฀currently฀an฀in-service฀TRS฀ member฀paid฀on฀the฀City฀of฀New฀York฀payroll฀through฀direct฀deposit฀or฀if฀you฀currently฀receive฀payments฀from฀TRS฀via฀฀EFT.฀ In฀either฀case,฀you฀may฀elect฀that฀your฀withdrawal฀be฀forwarded฀via฀EFT฀to฀the฀account฀where฀the฀above฀payments฀are฀deposited.฀ (Charter฀School฀employees,฀and฀City฀University฀of฀New฀York฀(CUNY)฀employees฀paid฀on฀the฀New฀York฀State฀payroll,฀are฀not฀eligible฀ to฀receive฀this฀payment฀via฀EFT.)฀฀If฀you฀are฀not฀eligible฀to฀receive฀your฀withdrawal฀via฀EFT,฀it฀will฀be฀mailed฀to฀your฀home฀address.฀

Please฀note฀that฀withdrawal฀checks฀may฀no฀longer฀be฀placed฀on฀hold฀for฀pickup฀at฀TRS.

If฀you฀elect฀to฀directly฀roll฀over฀all฀or฀part฀of฀your฀withdrawal,฀you฀must฀ile฀a฀“QPP฀Direct฀Rollover฀Election฀Form”฀(code฀RW29)฀in฀ conjunction฀with฀this฀application.฀฀Please฀note฀that฀the฀minimum฀amount฀that฀TRS฀will฀directly฀roll฀over฀to฀a฀successor฀program฀is฀$200.฀฀ (This฀amount฀may฀be฀greater฀depending฀on฀the฀successor฀program’s฀requirements.)฀฀See฀the฀“QPP฀Direct฀Rollover฀Election฀Form”฀for฀

more information.

In฀Part฀C:฀฀You฀must฀provide฀the฀requested฀information.

In฀Part฀D: You must read the attestation and sign and date this form.

In฀Part฀E: You must have this application notarized.

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GENERAL PROVISIONS

Vesting:

•฀฀฀For฀most฀members,฀vesting฀occurs฀upon฀attaining฀ive฀years฀of฀Total฀Service฀Credit.฀However,฀ten฀years฀of฀Total฀Service฀ Credit฀are฀required฀for฀those฀with฀a฀TRS฀membership฀date฀later฀than฀March฀31,฀2012฀(or฀December฀10,฀2009,฀for฀members฀ represented฀by฀the฀United฀Federation฀of฀Teachers).฀฀If฀you฀are฀not฀sure฀whether฀you฀are฀vested,฀or฀if฀you฀have฀questions฀about฀ vesting,฀please฀contact฀TRS’฀Member฀Services฀Center฀at฀1฀(888)฀8-NYC-TRS฀before฀iling฀this฀application.

•฀฀฀When฀non-vested฀members฀separate฀from฀service,฀their฀QPP฀accumulations฀would฀continue฀to฀accrue฀investment฀return/ interest฀for฀a฀limited฀period฀of฀time.฀฀If฀they฀separated฀from฀service฀on฀or฀before฀July฀13,฀1993,฀investment฀return/interest฀ stopped฀as฀of฀ive฀years฀after฀their฀separation฀date.฀฀If฀they฀separated฀from฀service฀on฀or฀after฀July฀14,฀1993,฀investment฀ return/interest฀would฀cease฀as฀of฀seven฀school฀years฀after฀their฀separation฀date.

AMCs฀Made฀under฀the฀Age฀55฀Retirement฀Program:

•฀฀฀Tiers฀II/III/IV฀members฀participating฀in฀this฀program฀make฀AMCs฀representing฀1.85%฀of฀their฀gross฀compensation;฀50%฀of฀AMCs฀ are deemed employee฀contributions,฀and฀50%฀are฀deemed฀employer฀contributions.฀(Some฀members฀may฀have฀a฀deicit฀in฀their฀ AMC฀balance;฀see฀below.)

•฀฀฀Members฀who฀were฀laid฀off฀from฀their฀TRS-eligible฀position฀for฀reasons฀of฀economic฀hardship฀are฀eligible฀to฀withdraw฀and/or฀roll฀ over฀the฀employee฀portion฀of฀their฀AMCs.

•฀฀For members who were laid off from their TRS-eligible position for reasons of economic hardship:฀฀If฀there฀is฀a฀deicit฀in฀the฀ employer portion฀of฀their฀AMCs฀at฀the฀time฀of฀withdrawal,฀the฀deicit฀amount฀would฀be฀deducted฀from฀the฀member’s฀employee฀ portion;฀any฀remaining฀employer฀AMC฀deicit฀would฀be฀deducted฀from฀the฀member’s฀ASF฀(Tier฀II)฀or฀MCAF฀(Tiers฀III/IV)฀balance.฀

For all other members: If฀there฀is฀any฀deicit฀(employer฀and/or฀employee฀portion)฀in฀their฀AMCs฀at฀the฀time฀of฀withdrawal,฀the฀฀ ฀

฀deicit฀amount฀would฀be฀deducted฀from฀the฀member’s฀ASF฀(Tier฀II)฀or฀MCAF฀(Tiers฀III/IV)฀balance.

TAX CONSEQUENCES

•฀฀฀The฀taxable฀portion฀of฀any฀withdrawn฀QPP฀funds฀is฀taxable฀upon฀receipt฀and฀will฀be฀reported฀to฀the฀IRS฀in฀January฀following฀the฀ calendar฀year฀in฀which฀it฀is฀distributed.฀฀The฀IRS฀requires฀that฀TRS฀withhold฀20%฀of฀any฀taxable฀amount฀you฀withdraw฀that฀you฀do฀ not฀instruct฀TRS฀to฀directly฀roll฀over฀into฀an฀eligible฀IRA(s)฀or฀other฀successor฀program(s).฀฀This฀20%฀will฀be฀forwarded฀to฀the฀IRS฀ and฀credited฀toward฀your฀federal฀taxes฀for฀the฀year฀of฀distribution.฀฀(Within฀60฀days฀of฀the฀distribution฀date,฀you฀may฀roll฀over฀any฀ taxable฀amount฀you฀receive,฀or฀roll฀over฀the฀entire฀amount฀of฀the฀distribution฀by฀replacing฀the฀20%฀withheld฀by฀TRS฀with฀money฀ from฀other฀sources.)

•฀฀฀If฀you฀have฀an฀outstanding฀and/or฀defaulted฀QPP฀loan฀balance(s)฀as฀of฀the฀date฀you฀ile฀this฀application,฀the฀total฀balance(s)฀ would฀be฀charged฀against฀your฀QPP฀accumulations,฀and฀your฀QPP฀accumulations฀available฀for฀withdrawal฀would฀be฀reduced.฀฀ Any฀outstanding฀balance฀would฀be฀deemed฀a฀distribution฀and฀reported฀to฀the฀IRS฀in฀January฀following฀the฀calendar฀year฀in฀ which฀it฀is฀deemed฀a฀distribution.฀฀For฀more฀information฀about฀outstanding฀and/or฀defaulted฀QPP฀loans,฀please฀see฀the฀

QPP Loans brochure.

•฀฀฀If฀a฀QPP฀loan฀is฀deemed฀a฀distribution฀in฀the฀same฀tax฀year฀in฀which฀you฀receive฀your฀QPP฀withdrawal,฀the฀IRS฀would฀require฀ TRS฀to฀withhold฀20%฀of฀the฀taxable฀portion฀of฀the฀deemed฀distribution฀from฀the฀QPP฀withdrawal฀(in฀addition฀to฀the฀20%฀ withholding฀required฀separately฀for฀the฀QPP฀withdrawal).฀฀The฀total฀amount฀withheld฀would฀be฀forwarded฀to฀the฀IRS฀and฀credited฀ toward฀your฀taxes฀for฀the฀current฀year.

Please฀note฀that฀ALL฀withdrawals฀may฀be฀subject฀to฀an฀additional฀IRS-imposed฀10%฀tax฀unless฀one฀of฀the฀following฀ exceptions฀applies:

•฀฀The฀withdrawal฀is฀made฀in฀conjunction฀with฀your฀separation฀from฀service฀during฀or฀after฀the฀year฀in฀which฀you฀attain฀age฀55;฀or

•฀฀The฀withdrawal฀is฀made฀during฀or฀after฀the฀year฀you฀reach฀age฀59½;฀or

•฀฀The฀withdrawal฀is฀a฀qualiied฀hardship฀withdrawal;฀or

•฀฀The฀withdrawal฀is฀made฀in฀conjunction฀with฀your฀disability฀retirement;฀or

•฀฀The฀withdrawal฀is฀made฀by฀your฀beneiciary฀in฀conjunction฀with฀a฀death฀beneit฀payment.

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PART฀D:฀฀Please฀read฀the฀following฀statement฀and฀sign฀and฀date฀below฀in฀the฀presence฀of฀a฀notary.

I certify that I have read this form in its entirety and understand all consequences of filing it with TRS. I hereby apply for the withdrawal of my QPP accumulations.

I understand that, upon my filing of this application, my membership in TRS (including my tier status) will be terminated. In addition, I acknowledge that, if I am a vested member, filing this application would nullify my vested rights, my right to a retirement allowance from TRS, and any other benefits based on my membership in TRS.

I also understand that any funds I have in TRS’ TDA Program will stop accruing investment return/interest as of the date that TRS receives this application. I further understand that, upon withdrawal of my QPP accumulations from TRS, I must also withdraw my TDA funds by filing a “TDA Withdrawal Application” (code TD32) (as well as a “TDA Direct Rollover Election Form” (code TD22) as applicable).

I certify that I have completed the appropriate portions of this form. I have also attached the required documentation pertaining to my official separation from service, as indicated in the Instructions of this form. I hereby certify that the information I have provided above is accurate to the best of my knowledge.

MEMBER’S฀SIGNATURE฀฀__________________________________________________฀฀DATE฀(M/D/Y)฀฀______________________

PART฀E:฀฀TO฀BE฀COMPLETED฀BY฀A฀NOTARY฀(NOTE:฀Attestation฀made฀outside฀the฀U.S.฀must฀be฀executed฀before฀an฀American฀consul.)

County of ฀ __________________________ )

On฀the฀_______________฀day฀of฀__________________________,฀__________,฀before฀me฀personally฀appeared฀the฀person฀

known฀to฀me฀to฀be฀___________________________________________________________________________,฀the฀individual฀who฀

executed฀the฀foregoing฀instrument฀and฀acknowledged฀to฀me฀that฀(s)he฀executed฀the฀same.

Signature:฀______________________________________________________________

Oficial฀Title:฀_____________________________________________________________

Expiration฀Date฀of฀Commission:฀_____________________________________________