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Member Transfer Form This form is for eligible Plan 2 members who want to transfer from Plan 2 to Plan 3. The transfer option is only available in January. Give completed form to your employer. Need help? Contact DRS. 800.547.6657 or 360.664.7000 ꔷ TTY: 711 www.drs.wa.gov Signature Required This form must be signed between Jan. 1 and Jan. 31. Sign and date this form on the day you submit it to your employer. • I have chosen to transfer from Plan 2 to Plan 3. I understand my plan selection is permanent. • If I did not select a contribution rate, I will be assigned the current default rate of 5%. Signature Date Contribution Rate and Investment Selection Plan 3 contribution rate: The percentage of your pay that will go toward your retirement. If you don’t choose, your default rate will be Option A. You can only change your rate when you change employers. Plan 3 investment: Choose one. You can change your investment selection at any time. Visit drs.wa.gov/login for more Plan 3 info. c Use the target date fund for my age (SELF Program) This option places you in the target date fund that assumes you’ll begin withdrawing funds at age 65. No additional action is needed if you choose this option. c I will choose my own investments (SELF Program) Once you submit this form and receive a letter that confirms your plan choice, visit drs.wa.gov/login to choose your investments (or call 888-327-5596). If you do not choose investments, your contributions will be invested in the target date fund that assumes you’ll begin withdrawing funds at age 65. c WSIB TAP (WSIB Program) This one-step fund is not adjusted based on your age, but is managed in the same way the state pension fund is invested. No additional action is needed if you choose this option. Option Your Contribution c Option A 5.0% c Option B (age based) 5.0% up to age 35 6.0% ages 35 to 44 7.5% age 45 and older c Option C (age based) 6.0% up to age 35 7.5% ages 35 to 44 8.5% age 45 and older c Option D 7.0% c Option E 10.0% c Option F 15.0% Employers: Use Plan Choice code 3X on January or February transmittal. Load completed form to the Upload Documents section of ERA. OR mail to: Department of Retirement Systems; PO Box 48380; Olympia, WA 98504-8380 Give completed form to your employer. Your Social Security number is needed so DRS can report to the IRS any funds paid to you. DRS will not disclose your Social Security number unless required to do so by law. (See IRC sections 6041(a) and 6109.) DRS MS 455 12/21 Personal Information System c Public Employees (PERS) c Teachers (TRS) c School Employees (SERS) Name (Last, First, Middle) Maiden Name Social Security Number Mailing Address City State ZIP Phone Number

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Page 1: Member Transfer Form Give completed form to your employer

Member Transfer FormThis form is for eligible Plan 2 members who want to transfer from Plan 2 to Plan 3. The transfer option is only available in January.

Give completed form to your employer. Need help? Contact DRS.800.547.6657 or 360.664.7000 ꔷ TTY: 711 www.drs.wa.gov

Signature RequiredThis form must be signed between Jan. 1 and Jan. 31. Sign and date this form on the day you submit it to your employer.

• I have chosen to transfer from Plan 2 to Plan 3. I understand my plan selection is permanent. • If I did not select a contribution rate, I will be assigned the current default rate of 5%.

Signature Date

Contribution Rate and Investment SelectionPlan 3 contribution rate: The percentage of your pay that will go toward your retirement. If you don’t choose, your default rate will be Option A. You can only change your rate when you change employers.

Plan 3 investment: Choose one. You can change your investment selection at any time. Visit drs.wa.gov/login for more Plan 3 info.

c Use the target date fund for my age (SELF Program) This option places you in the target date fund that assumes you’ll begin withdrawing funds at age 65. No additional action is needed if you choose this option.

c I will choose my own investments (SELF Program) Once you submit this form and receive a letter that confirms your plan choice, visit drs.wa.gov/login to choose your investments (or call 888-327-5596). If you do not choose investments, your contributions will be invested in the target date fund that assumes you’ll begin withdrawing funds at age 65.

c WSIB TAP (WSIB Program) This one-step fund is not adjusted based on your age, but is managed in the same way the state pension fund is invested. No additional action is needed if you choose this option.

Option Your Contributionc Option A 5.0%c Option B (age based)

5.0% up to age 35 6.0% ages 35 to 44 7.5% age 45 and older

c Option C (age based)

6.0% up to age 35 7.5% ages 35 to 44 8.5% age 45 and older

c Option D 7.0%c Option E 10.0%c Option F 15.0%

Employers: Use Plan Choice code 3X on January or February transmittal. Load completed form to the Upload Documents section of ERA. OR mail to: Department of Retirement Systems; PO Box 48380; Olympia, WA 98504-8380

Give completed form to your employer.

Your Social Security number is needed so DRS can report to the IRS any funds paid to you. DRS will not disclose your Social Security number unless required to do so by law. (See IRC sections 6041(a) and 6109.)

DRS MS 455 12/21

Personal Information System c Public Employees (PERS) c Teachers (TRS) c School Employees (SERS)Name (Last, First, Middle) Maiden Name Social Security Number

Mailing Address

City State ZIP Phone Number

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