Editing previous response:

Please fix the highlighted areas below before submitting.

Retirement Information & Meeting Request

Please complete the form below. Required fields marked with an asterisk *

Please complete this form and submit to Payroll.

A staff member will review the application and respond within 5 business days.

Employee Full Name*

Answer required for "Employee Full Name"

Prospective Retirement Date*

Answer required for "Prospective Retirement Date"

If you intend to leave a monthly pension benefit to a beneficiary, please complete the following items:

Beneficiary Name:

Answer required for "Beneficiary Name:"

Beneficiary Date of Birth

Answer required for "Beneficiary Date of Birth"

Beneficiary Relationship

Answer required for "Beneficiary Relationship"

Have you logged into MBOS in the last 6 months? *

Answer required for "Have you logged into MBOS in the last 6 months? "

Yes

Will you need assistance with your application?*

Answer required for "Will you need assistance with your application?"

Yes

Which meeting time works best for you?*

Answer required for "Which meeting time works best for you?"

10:00 AM

2:00 PM

The following information will be provided to you within 5 days of your request:

Confirmation Email

Answer required for "Confirmation Email"