Indicate the last day employed, prior to retirement, in a paid or unpaid capacity:

Is the employee currently on leave without pay or does the employee plan to go on leave without pay at any point prior to retirement? Please check one box:

Form 6201
Revised 7/9/2012
Page 1 of 2

Please attach to retirement application or fax to - Customer Service Annuity Claims (803) 737-7752. The purpose of this information is to determine an effective date of retirement for estimated payroll purposes.

Section I        PLEASE INDICATE THE LAST DAY OF REGULAR (PRE-RETIREMENT) EMPLOYMENT BELOW

Section II        FOR TEACHER AND EMPLOYEE RETENTION INCENTIVE PROGRAM  PARTICIPANTS ONLY

EMPLOYER CERTIFICATION OF LAST DAY EMPLOYED

SC Public Employee Benefit Authority

South Carolina Retirement Systems
Customer Annuity Claims
PO Box 11960, Columbia SC 29211-1960

(DATE OF RETIREMENT)

Please call SC Retirement Systems Customer Service with any questions: (800) 868-9002 (in state) or (803) 737-6800

* For TERI participation, this termination date should be no more than one day prior to TERI start date (effective date of retirement) so as to certify that the member was actively employed upon TERI participation.  For all retirees, complete Section I.  For TERI retirees, complete Sections I and II.

RETIREE HEALTH INSURANCE

Please discuss retiree health insurance with your employee who is anticipating retiring or participating in TERI.  Although one may be eligible to retire it does not automatically make one eligible for retiree health insurance.  Therefore, the consideration of a termination date as it relates to retiree health insurance coverage maybe of vital importance, prior to retirement. 

Please submit a corrected copy as soon as possible should any information change.  The TERI participant or employer should notify the Retirement Systems' Payroll Department, either by telephone or in writing, three months prior to the TERI participant's TERI ending date.                                   

(MAXIMUM OF 60 MONTHS)

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. 

TERI End Date:

Number of Months:

*TERI Start Date:

Date:

Fax Number:

Phone Number:

Job Title:

Completed by:

Employer Code: 

Employer Name: 

SSN:  

Planned Retirement Date:

Retiring Member's Name:

Authorized Employer Signature:

This is to certify that in conjunction with the above-named member's SCRS service retirement, the employer acknowledges the member's participation in the Teacher and Employee Retention Incentive (TERI) program on the TERI start date below and the termination of his or her participation on the TERI end date below:

Email Address: