University of Connecticut University of UC Title Fallback Connecticut

Request for Retirement on October 1, 2017

  • Form Revised 9/8/17
  • * Anticipated Retirement Date does not represent a final commitment to nor a guarantee of retirement date.
  • Retirement Plan: (Please see: http://www.osc.ct.gov/empret/stateretire.htm)
    Alternate Retirement Plan (ARP): (Please see: http://www.osc.ct.gov/rbsd/arpinfo/Amended12014.pdf)
  • Annuitant Name:Relationship:Annuitant Date of Birth:Date of Marriage (if applicable) 
  • Employee Home Mailing Address: StreetCity, State, Zip Code 
  • NEXT STEPS
    PLEASE NOTE: Retirement applications will be processed in the order in which they are received in Human Resources. A Retirement Specialist will contact you to schedule an appointment to complete the retirement paperwork and collect your proof documents. You will need to provide copies of the following documents:
    • Birth Certificate of:
      • Yourself
      • Spouse (if married/partnered)
      • Contingent Annuitant Birth Certificate (if applicable)
      • Dependent Birth Certificate (if applicable)
    • Marriage Certificate, Civil Union Certificate (if married/partnered)
    • Bring your Medicare card or copy of card to appointment
    If you were born in the United States, a passport is not an accepted proof document by the Office of the State Comptroller’s Retirement Services Division. You will need to request a birth certificate from the city where you were born.

    If you are planning to have your pension direct deposited, please bring your bank account number and routing number.

    IMPORTANT: Incomplete applications and missing proof documents will cause a delay in processing your retirement application and could result in pension checks being delayed.