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Get Maine Pers Ac0003 Form

EPERS Member ROLLOVER / DIRECT TRANSFER REQUEST / CERTIFICATION FORM (For Purchase of Service Credit) Employer: The Maine Public Employees Retirement System is a tax qualified defined benefit plan and, for the purchase of service credit, accepts direct rollovers and direct transfers from qualified 401(a) and 401(k) plans, 403(b) plans, l governmental 457(b) plans and from non-Roth IRAs. Member Name: Social Security #: Mailing Address: D.O.B. City: Telephone Number: Work( State: ) Home.

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