Forms

You need the free Adobe® Reader® to view these forms. Please keep a copy of all completed forms for your records. If you have problems viewing any of these forms or would like a copy mailed to you, contact us.

Completed forms can be submitted online using the new Document Upload functionality available in Web Member Services. You can also mail or fax them to our office.

Basic Forms

Direct Deposit Authorization for Monthly Benefit Payments (pdf, 354 KB) You can also update your monthly benefit direct deposit information online using Web Member Services.
Direct Deposit Authorization Form (Lump-Sum Option) (pdf, 355 KB)
Member Information Change Form (pdf, 478 KB) Use this form to request a change of your personal information, such as name or address. You can also update your mailing address, telephone number or email address online using Web Member Services.
Release of Information Authorization (pdf, 264 KB)
Tax Withholding Authorization for Monthly Benefits (pdf, 414 KB) You can also update your monthly benefit tax withholding information online using Web Member Services.
Working After Retirement Record-Keeping Form (pdf, 484 KB) Use this form if you are a PEERS retiree working for a covered employer.

Service Retirement

Service Retirement Application Packet (pdf, 1142 KB) You can also apply for retirement online using Web Member Services.
PLSO Distribution Form (pdf, 509 KB) If you are eligible and choose the Partial Lump Sum Option (PLSO) at retirement, you must also print and complete this form.

Reinstatement and Service Purchases

If you plan to pay for a reinstatement or purchase with money rolled over from a qualified account, please complete the PEERS Rollover Certification form.

Purchase Applications

Not all purchase applications are available online. If you do not see the form you need, contact us.

Military Service Purchase Application (pdf, 332 KB)
Private School Employment Service Purchase (pdf, 766 KB)
PSRS Service Purchase Application (pdf, 328 KB)
Public School Service Purchase Application (pdf, 456 KB)
Social Security-Covered Employment Purchase Application (pdf, 371 KB) A Detailed Earnings Statement from Social Security Administration (http://www.socialsecurity.gov/online/ssa-7050.pdf) is required with your purchase application for Social Security-covered service.
Supplemental Service Purchase Application Form (pdf, 317 KB)
Unpaid Maternity Leave Purchase Application (pdf, 583 KB)
Vo-Tech Service Purchase Application (pdf, 426 KB)

Beneficiary Designations

Pre-Retirement Nomination of Beneficiary Form (pdf, 485 KB)
Post-Retirement Beneficiary Designation (Term-Certain Plans) (pdf, 386 KB)
Post-Retirement Beneficiary Designation (Lump-Sum) (pdf, 888 KB)
Disability Retirement Nomination of Beneficiary Form (pdf, 580 KB)

Disability Retirement

Authorization for Release of Medical Records (pdf, 488 KB)
Disability Retirement Application (pdf, 664 KB)
Disability Retirement Application Packet (pdf, 782 KB)