Form PERS01F0030 DMC "Employer Contribution by Check Under Agreement and Election to Prefund Other Post-employment Benefits" - California

What Is Form PERS01F0030 DMC?

This is a legal form that was released by the California Public Employees' Retirement System - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2007;
  • The latest edition provided by the California Public Employees' Retirement System;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PERS01F0030 DMC by clicking the link below or browse more documents and templates provided by the California Public Employees' Retirement System.

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Download Form PERS01F0030 DMC "Employer Contribution by Check Under Agreement and Election to Prefund Other Post-employment Benefits" - California

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S
Employer Contribution By Check Under
Agreement and Election to Prefund Other Post-Employment Benefits
Employer Name
CERBT Account Number
Employer Address
Authorized Employer Representative Name
Title
Telephone Number
Signature
Effective date of Agreement and Election to Prefund Other Post-Employment Benefits:
/
/
Check Number
Amount of Contribution
Notes:
Contributions to the Prefunding Plan are governed by the terms of the Agreement and Election to Prefund Other
Post-Employment Benefits (Agreement).
To ask questions concerning contributions to the Prefunding Plan, email CERBT4U@calpers.ca.gov, or call
1-888-225-7377.
For proper crediting to your prefunding account, please complete this form and mail with
your check payable to CalPERS at the following address:
CalPERS
FRAS – Cash Payment & Processing Unit
PO Box 942703
Sacramento, CA 94229-2703
In addition, please email an electronic copy of this form to
FCSD_Cash_Management@calpers.ca.gov
to ensure timely processing of your contribution.
For CalPERS use only
Bank Deposit Code: PEB
Deposit Date
/
/
(mm/dd/yyyy)
PERS01F0030 DMC (02-2007)
S
Employer Contribution By Check Under
Agreement and Election to Prefund Other Post-Employment Benefits
Employer Name
CERBT Account Number
Employer Address
Authorized Employer Representative Name
Title
Telephone Number
Signature
Effective date of Agreement and Election to Prefund Other Post-Employment Benefits:
/
/
Check Number
Amount of Contribution
Notes:
Contributions to the Prefunding Plan are governed by the terms of the Agreement and Election to Prefund Other
Post-Employment Benefits (Agreement).
To ask questions concerning contributions to the Prefunding Plan, email CERBT4U@calpers.ca.gov, or call
1-888-225-7377.
For proper crediting to your prefunding account, please complete this form and mail with
your check payable to CalPERS at the following address:
CalPERS
FRAS – Cash Payment & Processing Unit
PO Box 942703
Sacramento, CA 94229-2703
In addition, please email an electronic copy of this form to
FCSD_Cash_Management@calpers.ca.gov
to ensure timely processing of your contribution.
For CalPERS use only
Bank Deposit Code: PEB
Deposit Date
/
/
(mm/dd/yyyy)
PERS01F0030 DMC (02-2007)