Form 2-1895 Application for Military Service Credit for Pension Benefit Calculation - Alaska

Form 2-1895 is a Alaska Department of Administration form also known as the "Application For Military Service Credit For Pension Benefit Calculation". The latest edition of the form was released in September 1, 2018 and is available for digital filing.

Download an up-to-date Form 2-1895 in PDF-format down below or look it up on the Alaska Department of Administration Forms website.

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PERS
Application for
FOR OFFICE USE ONLY
Military Service Credit for
PUBLIC EMPLOYEES’ RETIREMENT SYSTEM
Pension Benefit Calculation
ALASKA DIVISION OF
Retirement
Benefits
and
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
TO THE MEMBER:
To receive PERS credit to potentially increase the amount of your monthly benefit for military service, you must: (1) be vested (five
paid-up years of PERS service); (2) complete this application; and (3) provide legible copies of your separation forms (DD or GG forms
214 or other documentation) verifying your beginning and ending dates of active duty and your honorable discharge.
If you need to obtain documentation of your military service, write to:
National Personnel Records Center, Civilian Personnel Records Facility
1 Archives Drive
St. Louis, MO, 63138
Be sure to include your military service and Social Security number, branch of service, and approximate dates of service.
If you vested during this current year, please do not submit your application until the end of the year. Your vesting year salary must be
verified before we can process your claim.
NAME (FIRST, MI, LAST)
LAST 4 OF SOCIAL SECURITY NUMBER OR RIN
MAILING ADDRESS (STREET OR P.O. BOX)
CITY
STATE
ZIP+4
EMPLOYER
HOME TELEPHONE NUMBER
State of Alaska, Department of
WORK TELEPHONE NUMBER
Political Subdivision
I wish to claim
years,
months and
days of military service (no more than five years may be claimed). I understand
that military service which has been credited in the Public Employees’ Retirement System (PERS) is not creditable in the TRS. I
understand this claim is for additional service credit to be used in the calculation of my future monthly benefit. I certify that if I was first
hired under PERS after June 30, 1986 that
I am eligible for a federal retirement benefit for this same service.
I am not eligible for a federal retirement benefit for this same service.
I am a retired National Guard or Reserve Unit member and I am eligible for a federal retirement benefit for this same service.
I understand that compound interest as prescribed by regulation will be added to my military indebtedness until it is paid in full or
I retire, whichever occurs first.
SIGNATURE
DATE
2-1895 (Rev. 9/18)
G:\Communications_Only\200 Products\206\PERS\02-1895.indd
PERS
Application for
FOR OFFICE USE ONLY
Military Service Credit for
PUBLIC EMPLOYEES’ RETIREMENT SYSTEM
Pension Benefit Calculation
ALASKA DIVISION OF
Retirement
Benefits
and
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, AK 99811-0203
Fax: (907) 465-3086
TO THE MEMBER:
To receive PERS credit to potentially increase the amount of your monthly benefit for military service, you must: (1) be vested (five
paid-up years of PERS service); (2) complete this application; and (3) provide legible copies of your separation forms (DD or GG forms
214 or other documentation) verifying your beginning and ending dates of active duty and your honorable discharge.
If you need to obtain documentation of your military service, write to:
National Personnel Records Center, Civilian Personnel Records Facility
1 Archives Drive
St. Louis, MO, 63138
Be sure to include your military service and Social Security number, branch of service, and approximate dates of service.
If you vested during this current year, please do not submit your application until the end of the year. Your vesting year salary must be
verified before we can process your claim.
NAME (FIRST, MI, LAST)
LAST 4 OF SOCIAL SECURITY NUMBER OR RIN
MAILING ADDRESS (STREET OR P.O. BOX)
CITY
STATE
ZIP+4
EMPLOYER
HOME TELEPHONE NUMBER
State of Alaska, Department of
WORK TELEPHONE NUMBER
Political Subdivision
I wish to claim
years,
months and
days of military service (no more than five years may be claimed). I understand
that military service which has been credited in the Public Employees’ Retirement System (PERS) is not creditable in the TRS. I
understand this claim is for additional service credit to be used in the calculation of my future monthly benefit. I certify that if I was first
hired under PERS after June 30, 1986 that
I am eligible for a federal retirement benefit for this same service.
I am not eligible for a federal retirement benefit for this same service.
I am a retired National Guard or Reserve Unit member and I am eligible for a federal retirement benefit for this same service.
I understand that compound interest as prescribed by regulation will be added to my military indebtedness until it is paid in full or
I retire, whichever occurs first.
SIGNATURE
DATE
2-1895 (Rev. 9/18)
G:\Communications_Only\200 Products\206\PERS\02-1895.indd
FOR PERS USE ONLY – MILITARY SERVICE COMPUTATION
ENTRY INTO MILITARY
SERVICE
SEPARATION FROM MILITARY SERVICE
CREDITABLE SERVICE
.
.
=
.
YEARS
.
.
=
.
YEARS
.
.
=
.
YEARS
=
.
TOTAL YEARS OF CREDITABLE MILITARY SERVICE
YEARS
VESTING DATE:
INTEREST BEGINS:
DATE
VERIFIED AND COMPUTED BY
CHECKED BY
FOR PERS USE ONLY - CALCULATION
Monthly
Hourly
Rate of Pay for
...............................................................................
$
X
Monthly
Hourly
Rate of Pay for
...............................................................................
$
=
Calculated Earnings for Unemployed Portion of
.........................................................................
$
+
ACTUAL EARNINGS..................................................................................................................................................................................
$
=
CALCULATED/ANNUAL SALARY .............................................................................................................................................................
$
X
% =
CONTRIBUTION RATE ..............................................................................................................................................................................
ANNUAL CONTRIBUTION .........................................................................................................................................................................
$
X
YEARS OF MILITARY SERVICE ...............................................................................................................................................................
=
TOTAL INDEBTEDNESS PRINCIPAL .......................................................................................................................................................
$
DATE
COMPUTED BY
2-1895 (Rev. 9/18)
G:\Communications_Only\200 Products\206\PERS\02-1895.indd

Download Form 2-1895 Application for Military Service Credit for Pension Benefit Calculation - Alaska

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