SC Public Employee Benefit Authority
South Carolina Retirement Systems
202 Arbor Lake Drive, Columbia, SC 29223
Withholding Certificate for Monthly Benefit Payments
Sign in blue or black ink
Phone Number with Area Code
First Name/Middle Initial
Check appropriate system:
Federal Income Tax Withholding
Complete the following applicable lines:
Check box if you do not want any federal income tax withheld from your monthly annuity payment.
(Do not complete lines 2 or 3.)
Total number of exemptions and marital status you are claiming for withholding from each monthly annuity payment. (You may also designate an additional dollar amount on line 3.)
Additional amount, if any, you want withheld from each monthly annuity payment.
Note: For monthly annuity payments, you cannot enter an amount here without entering the number (including zero) of allowances on line 2. This amount will be withheld in addition to the amount calculated using the marital status and allowances from line 2 above.
South Carolina State Income Tax Withholding
Complete the following applicable lines:
Check box if you do not want any South Carolina state income tax withheld from your monthly annuity payment.
(Do not complete lines 5 or 6.)
Total number of exemptions you are claiming for withholding from each monthly annuity payment. (You may also designate an additional dollar amount on line 6.)
Additional amount, if any, you want withheld from each monthly annuity payment.
Note: For monthly annuity payments, you cannot enter an amount here without entering the number (including zero) of allowances on line 5. This amount will be withheld in addition to the amount calculated using the marital status and allowances from line 5 above.
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 PUBLIC EMPLOYEE BENEFIT AUTHORITY. THE SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT.
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(OR mark with "X" with two witnesses OR Power of Attorney, if on file with the Retirement Systems)
This form must be signed and dated. See notes on Page 2.
Form 7202
Revised 6/27/2017
(Enter number of exemptions)
(Enter number of exemptions)