INSTRUCTIONS: ALABAMA INSURANCE AUTHORIZATION (Form TRS 12-T) Members of the Teachers' Retirement System of Alabama who wish to have insurance premiums deducted from their retirement benefits do so by filing a form TRS 12-T. This document can be obtained from the website maintained by the Teachers' Retirement System of Alabama. Alabama Insurance Authorization TRS 12-T Step 1: On the first line, enter your first, middle and last name. Alabama Insurance Authorization TRS 12-T Step 2: On the second line, enter your Social Security number. Alabama Insurance Authorization TRS 12-T Step 3: On the third line, enter your full telephone number, including the area code. Alabama Insurance Authorization TRS 12-T Step 4: On the fourth line, enter your P.O. box number or street address. Alabama Insurance Authorization TRS 12-T Step 5: On the fifth line, enter your city, state and zip code. Alabama Insurance Authorization TRS 12-T Step 6: The next section is for documentation of the insurance policies in question. In the first section of the table provided, enter the name of the insurance company in the first box. Alabama Insurance Authorization TRS 12-T Step 7: In the second box, enter the policy number. Alabama Insurance Authorization TRS 12-T Step 8: In the third box, enter the monthly premium paid. Alabama Insurance Authorization TRS 12-T Step 9: In the fourth box, enter the start date for deductions. Alabama Insurance Authorization TRS 12-T Step 10: In the fifth box, enter the insurance company address. Alabama Insurance Authorization TRS 12-T Step 11: Provide the same information for up to three other policies in the rest of the table. Alabama Insurance Authorization TRS 12-T Step 12: Sign and date the form. Alabama Insurance Authorization TRS 12-T Step 13: Give the form to your employer for certification. In the first two blanks, your name will be entered. Alabama Insurance Authorization TRS 12-T Step 14: In the third blank, the date on which the last deduction was performed will be entered. Alabama Insurance Authorization TRS 12-T Step 15: A payroll clerk should sign and date the bottom of the hpage. Alabama Insurance Authorization TRS 12-T Step 16: The form should be submitted to the Teachers' Retirement System of Alabama by your employer via the address provided at the top the top of the page.