THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SOUTH CAROLINA RETIREMENT SYSTEMS. THE SOUTH CAROLINA RETIREMENT SYSTEMS RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT.
For more information, please contact Customer Services at 803-737-6800, 800-868-9002 (within SC only), or www.retirement.sc.gov.
SOCIAL SECURITY NUMBER:
Member Signature
ADDRESS:
NEW ADDRESS
ZIP CODE:
STATE:
CITY:
PHONE NUMBER:
PREVIOUS ADDRESS
MEMBER CHANGE OF ADDRESS
SC Public Employee Benefit Authority
South Carolina Retirement Systems
P.O. Box 11960, Columbia, SC 29211-1960
Form 1117Revised 7/6/2012
FIRST/MIDDLE NAME:
LAST NAME & SUFFIX:
SELECT ONE OF THE FOLLOWING:
Date
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