SCNG SERVICE RETIREMENT APPLICATION

SC Public Employee Benefit Authority
South Carolina Retirement Systems
P.O. Box 11960, Columbia, SC 29211-1960

Form 6101N
Revised 7/10/2018

Office Use Only

Age 60 with at least 20 years of total creditable military service (including National Guard, reserve, and active duty), of which at least 15 years and the final 10 years prior to retirement must have been served in the SC National Guard.

Must have received an honorable discharge from the SC National Guard.

The member must be honorably discharged from the South Carolina National Guard as of the effective date of retirement.

The Retirement Systems suggests that you file your application six months prior to your planned date of retirement.

SECTION II

INSTRUCTIONS

Attach a copy of your birth certificate and your current driver's license or special identification

card issued by your state Department of Transportation or Public Safety.

All payments are made by direct deposit. Please complete Form 7204 (Direct Deposit Authorization). 

Disclaimer: Service credit previously recorded on any statements or benefit estimates does not necessarily constitute automatic eligibility to retire. All accounts are audited to determine eligibility. The Retirement Systems suggests that you file your application six months prior to your planned retirement date so the Retirement Systems may audit your account, determine eligibility, and notify you in writing that you are eligible for retirement. The following is provided as general information and is subject to change based on prevailing statutes at the time of the event in question. Contact Customer Services at (800) 868-9002 or (803) 737-6800 for forms, information about current statutes, or assistance with retirement matters.

AUTHORIZATION: I hereby authorize the Retirement Systems to make any and all payments due in accordance with the rules, regulations, and statutes of the South Carolina National Guard Retirement System. I agree on behalf of myself and my heirs and assigns that any payments so made shall be a complete discharge of the claim or claims and shall constitute a release of the Retirement Systems from any further obligation on account of the benefit(s).

SECTION III

SIGNATURE STATEMENT

Please read the Authorization section of the instructions before signing this form IN BLUE INK.

MEMBER'S SIGNATURE

(Certified copy of legal authorization required with signature other than applicant's)  

(Required only when signed by mark) 

WITNESS

DATE

DATE

I hereby certify I have read and understand the information on the application, including the authorization, and I agree to the terms stated.

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. 

My signature indicates that I understand that it is my responsibility to contact my employer or health insurance provider regarding my eligibility for retiree health insurance, if applicable.

RETIREE HEALTH INSURANCE

If you are determined to be eligible for retirement, it does not automatically make you eligible for retiree health insurance. Prior to selecting your retirement date, you should contact your employer or health insurance provider to determine if you will be covered for retiree health insurance, if applicable.

SOCIAL SECURITY NUMBER

LAST NAME & SUFFIX (Jr., Sr., etc.)

FIRST/MIDDLE NAME

Address

Date of Birth (proof required)

Sex

City

State

ZIP+4

Home Phone

Work Phone

Email Address

Please contact PEBA's Customer Contact Center with any questions at 803.737.6800 or 888.260.9430, or www.peba.sc.gov.