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 (Lump Sum) (pdf, 355 KB)
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.
Member Information Change Form (pdf, 557 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, 280 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.
Partial Lump Sum Option Distribution Election (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/Transfer Certification form.

Purchase Applications

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

Application to Purchase Active Duty Military Service (pdf, 332 KB)
Application to Purchase Private School Employment (pdf, 766 KB)
Application to Purchase PSRS-Covered Employment (pdf, 328 KB)
Application to Purchase Public School Service (at schools not covered by PEERS) (pdf, 456 KB)
Application to Purchase Social Security-Covered Employment (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.
Application to Purchase Supplemental Service (pdf, 317 KB)
Application to Purchase Unpaid Maternity/Paternity Leave (pdf, 583 KB)
Application to Purchase Vo-Tech Service (pdf, 426 KB)

Beneficiary Designations

Pre-Retirement Beneficiary Designation (pdf, 503 KB)
Post-Retirement Beneficiary Designation (Term-Certain Plans) (pdf, 402 KB)
Post-Retirement Beneficiary Designation (Lump-Sum) (pdf, 933 KB)
Disability Retirement Beneficiary Designation Form (pdf, 598 KB)

Disability Retirement

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