Forms and Publications - New York City Police Pension Fund

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Please carefully follow all instructions stated on the form.

NOTE: Some forms require notarization.

Form Number	General Applications
10	ITHP (Increased-Take-Home-Pay)
20	50% Additional Contributions
30	Pension Annuity Deductions Discontinuance/Reinstatement
40	Pension Loan Application
50	Loans - Request To Change Amount of Repayment
60	Change of Designated Beneficiary
61	Supplemental Beneficiary Designation and Change
70	Change of Address (Retirees only)
80	Refund of Excess
90	Rollover Election
100	Loan Cancellation
110	START or CHANGE Direct Deposit/EFT (Retirees only)
120	Federal Income Tax Withholding Form
130	Discontinuance of Service
140	Designation of Guardian
150	Certification Of Employment (212 Wavier)
160	Shortage Request
170	WTC Disability Law & Application
180	VSF Suspension
190	STOP Direct Deposit/EFT (Retirees only)
195	MCU Payroll Deduction Form (Retirees only)
220	Pension Statement Request (Active Members only)
230	Lost Check Affidavit
240	Pension Award Certification Request (Retirees only)

	Buy Back Applications
300	Military Service Credit--Chap 548
310	Child Care Credit--Chap 594
330	Bosnia Bill--Chap 606
340	Prior Service Credit--Chap 646
350	Prior Service Credit --Chap 552
360	Deferred Compensation Plan - In Service Distribution Form
370	Amend Prior State Service
380	Application for Prior Credit for service as a NYC EMT Under --Chap 728 Laws of 2004
390	Application to Amend Service Credit -- Chap 498 Laws of 2005

	Transfer of Membership Forms
500	NYS Employee Retirement System
510	NYC Fire Department
520	Board of Education
530	NYC Employee Retirement System

	Legal Forms
550	Sample DRO Forms
560	Request for Pension Valuation in a Matrimonial Action