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Forms

Beneficiary/Survivor

Beneficiary Designation

In addition to designating the beneficiary of retirement monies, the form includes a section for a $150,000 death benefit for PERS, PSERS, SERS, TRS, LEOFF and WSPRS members who die as a result of an injury sustained in the course of employment, or an occupational disease or infection that arises naturally and proximately out of covered employment.

Legal Order Payee Beneficiary Designation

Designate beneficiary information in case of death prior to complete distribution of benefits. For those receiving a retirement benefit as a result of a legal order.

Name/Address Change

For retirees, beneficiaries and former members. Active members: please update your name and/or address through your employer.

Deferred Compensation Program

Affidavit of Attorney in Fact

This completed form must accompany your Power of Attorney document.

Deferred Compensation Program Forms

Forms are available at the DCP Web site.

Finance Management

Information Release Authorization

Release your account information to a third party, such as your financial planner.

 

Plan 3 Change of Investment Program

Plan 3 members use this form to select a new investment program for future contributions; this form should be turned in to the employer.

Judicial Benefit Multiplier Program

Judicial Benefit Multiplier Election Form (PERS)

This form is for judicial members of the Public Employees' Retirement System who choose to participate in the Judicial Benefit Multiplier Program.

Judicial Benefit Multiplier Election Form (TRS Plan 1)

This form is for judicial members of the Teachers' Retirement System Plan 1 who choose to participate in the Judicial Benefit Multiplier Program.

New Member

Member Information Form

For new PERS, SERS or TRS members; Plan 2 members who choose to transfer to Plan 3; or Plan 3 members returning to eligible employment.

Enrollment Form

For new members of LEOFF or WSPRS; members returning to a LEOFF or WSPRS eligible position; or PERS elected or Governor-appointed officials; city managers; or chief administrative officers of a court, port district, or public utility district.

Plan 3

Plan 3 forms

Retiree or Withdrawn/Inactive Member

Authorization for Direct Deposit

Have your retirement benefit deposited directly into your personal bank account. You should also complete an IRS form W-4P to advise the correct tax amount to be withheld.

LEOFF Plan 2 Retiree Re-employment Form

This form must be completed by a LEOFF Plan 2 retiree returning to work in a PERS, PSERS, SERS, or TRS eligible position. Retirees must choose between two options: to become a member of PERS, PSERS, SERS or TRS and temporarily suspend their LEOFF benefit; or not become a member and continue to receive their LEOFF benefit.

Substitute Teacher/School Employee

SERS Plan 2 and Plan 3 Substitute's Guide (Includes Form)

Information and forms packet for substitute teachers who belong to SERS Plan 2 or Plan 3.

TRS Plan 2 and Plan 3 Substitute's Guide (Includes Form)

Information and forms packet for substitute teachers who belong to TRS Plan 2 or Plan 3.

Withdrawals

Withdrawal of Retirement Contributions (For Plan 1 and Plan 2 - Includes Form)

For Plan 1 and Plan 2 members who have terminated retirement covered-employment and who are eligible for withdrawal of contributions and interest earned. When completing the request to withdraw your contributions, members need to also complete an IRS form W-9 to verify Social Security Number prior to payment.

Withdrawal of Retirement Contributions (For Plan 3 - Includes Form)

See Plan 3 Request for Payment of Defined Contribution Funds.