For USCG Personnel Only

Retirement Certificate Order Form - To be submitted by member's Unit.

If you are an Active Duty member, certificates are automatically sent to your unit six-months prior to your retirement date. If the certificate is needed earlier than this, then select the “Early Request” option below.

Please note you must have approved orders in PeopleSoft to receive retirement certificates.

If you are a Reservists transferring into a RET-2 status or if you are a drilling reservists reaching age 60, your certificates will be sent to you automatically based on your Reserve Retirement Transfer Request (CG-PSC-2055A).

Please fill out the following form to order retirement certificates. A PSC representative will review the info, print the certificates, and mail to the Unit address provided below as soon as possible.

Fields with a next to them are required fields.

Only use this method for requesting certificates if one of the following applies:

If you have any other circumstances, please feel free to call us at (800) 772-8724.
Please enter the full name of the retiree:

Please enter the retiree's Employee ID Number:

Please verify the retiree's Employee ID Number:

Please choose the retirees rate/rank:

If the retirees Rate/Rank is not listed, please select "Not listed" in these boxes, and type the correct entry into the "Comments" area below.
Is the retiree Active Duty or Reserve?
Will a certificate be issued for retiring members spouse?
Please enter the retirees spouse's name (if applicable):

Please enter the date of the retirement ceremony:

Please enter the retirement date:

Please enter the active duty base date:

Please enter the retirees total years in service:

Please enter the unit's mailing address:

Please enter Point of Contact information, should we need to get in touch with you:

Please enter any other comments or requests here:

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Last Modified 8/22/2008