Commander Navy Installations Command Non Appropriated Fund Retirement Plan Retirement Application General Information To Be Completed By Local NAF Personnel Office (Please Type) Employee Name: Social Security (last four only): Other DoD NAF Service: Yes No NAFI Type: Prior Enrollment in FERS/CSRS: Yes No Regular Hire Date: Birth Date: (attach RP-12) Termination Date: Retirement Date: Number of unused Sick Leave Hours: Medical Plan: No Yes Date of enrollment: (Attach enrollment form) Authorized Representative Signature: Date: Contact Number:
Annuity Selection To Be Completed By Employee Marital Status: Married (Complete Section I) Single (Complete Section II) Section I Married Only Spouses Full Name: Birth Date: Unless you select annuity without survivors benefit below, your annuity will be paid with a survivors benefit to your spouse. Under the annuity with survivors benefit your spouse will receive 55% of your annuity should your spouse survive your death. Your spouse will continue to receive this payment until the spouse's death or remarriage before age 60. Your annuity will be reduced by 10% under annuity with survivor's benefit. Should you survive your spouse's death or you are no longer married, the 10% reduction will be removed after you notify Commander Navy Installations Command NAF Personnel and Benefits. Should you elect Annuity Without Survivor's Benefit. Your spouse will not receive an annuity after your death. Your designated beneficiary will receive the unpaid value of your contributions Selection of Survivor Benefits is a one time election and is not revocable. This election must be made prior to retirement processing. I have read and understand the explanation of my benefits above and I elect: (Please Initial Selection) Annuity Without Survivor's Benefit. Your spouse will not receive an annuity after your death. Your designated beneficiary will receive the unpaid value of your contributions. Complete RP-4 for beneficiary election. Spouse must complete Spousal Consent section. Annuity With Survivor's Benefit (not available to deferred annuitants)
Spousal Consent - This section must be completed by the spouse if the participant is married and made an election in Section III which did not designate the spouse as a beneficiary. I,, hereby acknowledge the effect and consent to the election made by my spouse to wave payment of her or his death benefit annuity. I understand by signing this consent, I may not receive any benefit from the Plan after death of my spouse. _ (Spouse signature/date) (Notary signature/date) (Date Commission Expires)
Section II Single Only Unless you select an annuity with survivor benefit to a named person having an interest, your designated beneficiary will receive the unpaid value of your contributions when you die. Should you select an annuity with survivor benefit to a named person having an interest; your designated beneficiary will receive 55% of your annuity if he/she survives your death. Your annuity will be reduced by 10% and will be further reduced by 5% for each full five years that your named recipient is younger than you. The maximum reduction is 40%. For example if your named person is five years younger than you your reduction is 15%, if the individual is eight years younger your reduction remains 15%, 11 years younger 20%, 30 years younger annuity reduction of 40%. Under certain conditions the full annuity may be restored, please see plan document. Selection of Survivor Benefits is a one time election and is not revocable. This election must be made prior to retirement processing. I have read and understand the explanation of my benefits above and I elect: (Please Initial Selection) Annuity With Survivor Benefit to A Named Person Having an Interest (not available to differed annuitants) Name of Individual (survivor): Full SSN: Address of Individual (survivor): Date of Birth of Individual (survivor): (must provide proof of age) Annuity Without Survivor Benefit: Your designated beneficiary will receive the unpaid value of your contributions. Complete RP-4 for beneficiary information for unused contributions.
Section III All Participants Social Security Offset. Your annuity is offset by a fraction of your Social Security benefit once you are age 62 or older. The payment you receive from the Social Security Administration is not impacted. You may elect to provide a copy of your Social Security Benefit estimate from the Social Security Administration. Should you not provide the benefit estimate we will calculate your Social Security Benefit using your last salary and the Social Security Administration calculator available on their web page. (Attach signed copy of SS Offset letter) I understand that I may elect to provide a Social Security Estimate from the Social Security Administration for use in the retirement benefit calculation. Required Documents Participants OPF Marriage Certificate - (if applicable) Verification of Age (birth certificate/dd-214 or RP-12) Social Security Administration Estimate (if provided) Copy of W-2s for High Three Earnings Proof of Age for Survivor Benefit to a Named Person Having an Interest (if applicable) Copy of Retirement Enrollment form Copy of Medical Enrollment form Copy of signed SS Offset Letter