- Employees’ Retirement System
Membership Registration
RS 5420
(Rev .
- 1/10)
Receipt Stamp
For OSC use only
Office of the New York State Comptroller
New York State and Local Retirement System
Employees’ Retirement System
Police and Fire Retirement System
110 State Street, Albany, New York 12244-0001
IF YOUR MEMBERSHIP IS OPTIONAL, DO NOT COMPLETE OR SUBMIT THIS FORM UNLESS YOU DESIRE TO BECOME A MEMBER.
- IMPORTANT INFORMATION: Has this person been registered to membership by means of the telephone or fax
registration system? Failure to contact that system could cause loss of the privilege of transferring membership.
- Day Year
To
Mo.
- Beneficiaries’ complete nam...
ERS Retirement Application 
