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, 419 KB) You can also update your monthly benefit direct deposit information online using Web Member Services.
Member Information Change Form (pdf, 508 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, 251 KB)
Tax Withholding Authorization for Monthly Benefits (pdf, 456 KB) You can also update your monthly benefit tax withholding information online using Web Member Services.
Working After Retirement Record-Keeping Form (pdf, 473 KB) Use this form if you are a PEERS retiree working for a covered employer.

Service Retirement

Service Retirement Application Packet (pdf, 1135 KB) You can also apply for retirement online using Web Member Services.
PLSO Distribution Form (pdf, 490 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 print and complete this form:

PEERS Rollover/Transfer Certification form and PEERS Rollover/Transfer Certification Instructions

Purchase Applications

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

Maternity Leave Purchase Application (pdf, 579 KB)
Military Service Purchase Application (pdf, 329 KB)
Private School Employment Service Purchase (pdf, 954 KB)
PSRS Service Purchase Application (pdf, 328 KB)
Public School Employment Purchase Application (pdf, 527 KB)
Social Security-Covered Employment Purchase Application (pdf, 350 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 (pdf, 319 KB)
Vo-Tech Service Purchase Application (pdf, 504 KB)

Beneficiary Designations

Pre-Retirement Beneficiary Designation Form (pdf, 677 KB)
Post-Retirement Beneficiary Designation Form (Term-Certain Plans) (pdf, 814 KB)
Post-Retirement Beneficiary Designation (Lump-Sum) (pdf, 871 KB)
Disability Retirement Beneficiary Designation Form (pdf, 674 KB)

Disability Retirement

Authorization for Release of Medical Records (pdf, 493 KB)
Disability Retirement Application (pdf, 610 KB)
Disability Retirement Application Packet (pdf, 872 KB)