Standard Form 2807
Register of Separations
July 1980 7540-00-634-4259
FPM Supplement 831-1
Previous editions not usable.
Civil Service Retirement System
Agency Date Page No.
Bureau or Reporting Unit Location Payroll Office No.*
Current Year Total Retirement
Name and Date of Birth Retirement Deductions Deductions to Credit Date of Separation
(for agency use only) of Employees and Remarks, if any
(1) (2) (3) (4)
Totals Brought Forward from Page _____
Accumulated Totals to Date
Instructions: One copy of this register must accompany 2806's transmitted to the Office of Personnel Management and
one copy sent to agency retirement officer by bureau or reporting unit.
*Give payroll office number of submitting office.