Logo: AFTRA Retirement Fund

Request for Pension Analysis

Participant Name:


Participant Social Security No.:

Participant Date of Birth:

Aftra Retirement Fund No.


Projected Retirement Date(s):
You must enter at least one date and you may enter up to four dates.
Please note that Projected Retirement Date(s) should reflect the 1st of the month.


Beneficiary Name*:


Beneficiary's Relationship to Participant:

Beneficiary Date of Birth:

* Your designated beneficiary is entitled to receive a portion of your benefit if he or she outlives you. Please note if you are married and name someone other than your spouse as your beneficiary, we require your spouse's notarized written consent when you apply for your pension.

Mailing Address

Address Line 1:

Address Line 2:



State: ZIP Code:

Please check here if you would like your pension analysis emailed to you, only.

Please check here if you would like your pension analysis emailed and mailed.

If an option is not selected, your pension analysis will be mailed to the mailing address indicated above.

Area Code and Telephone No.

Email Address:

Return signed and completed form to the AFTRA Retirement Fund via email by clicking HERE, by fax at (212) 499-4928 or by mail to the following address:

AFTRA Retirement Fund
Attention: Retirement Services
261 Madison Avenue, 7th Floor
New York, NY 10016-2309
Phone: (800) 562-4690

RPPA.02 Rev. 06-20