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Forms

All LSERS Portable Document Format (pdf) forms can be downloaded and completed online.  You MUST have the Adobe Acrobat Reader (2.1 or higher) installed on your computer to view pdf documents. Click Here if you need to download Adobe Acrobat Reader.

Print the completed form and send it to us by mail or fax.  If you are having trouble downloading the form, click here.

1 Authorized Signatures and Employer Contacts (Online)
2 Enrollment Application/Employee Notification (Online)
2AC Change of Address Authorization
2F Forfeiture of Benefits Attestation
2R Election to Retain Membership
2SS Statement Concerning Your Employment in a Job Not Covered by Social Security
3 Named Beneficiary
4B Contributions Correction Report (Online)
4C Contribution Payments Transmittal (Online)
4P Prior Year Correction of Earnings and Contributions
W4P Withholding Certificate for Pension or Annuity Payments
4T Employment Terminations (Online)
5 Service Credit Verification
5PT Report on Part-time Service
5WC Report on Workers’ Compensation
7 Application for Refund of Member Contributions
7D Application for Refund of Contributions to Beneficiary
8 Authorization for Direct Deposit
9 Application for Transfer or Reciprocal Recognition of Service
9A Application for Purchase of Service
9RO Rollover/Trustee-to-Trustee Transfer Acceptance
10 Application for Service Retirement, IBRP, or DROP
10A Employer Certification
10C Application for Retirement After DROP
11 Spousal Consent DROP IBRP Account
12 Application for Disability Retirement
12B Supervisor Statement of Disability
12C Physician Report of Disability
13 Application for Survivor Benefit
13B Student Certification
13C Certificate of Heirship
15 Re-employment of Retiree – Earnings Report (Online)
15N Retiree Return-to-Work Notification (Online)
16 Request for Monthly Benefit Estimate
18 Member Authorization for Income Verification
Update your beneficiary information: 3
Change your address: 2AC
Member Authorization for income verification: 18
Request a monthly benefit estimate: 16
Request to purchase service or repay refunded service: 9A
Request a transfer of service or reciprocal agreement from a public retirement system: 9
Request a refund of your contributions: 7
Change your federal tax withholding: W4P
Have your check sent directly to a financial institution: 8
Change your address: 2AC
Member authorization for income verification: 18
Update your beneficiary information: 3
Apply for Service Retirement, IBRP, or DROP: 10
Apply for Retirement after DROP: 10C
Apply for Disability Retirement: 12
Submit application for Survivor’s Benefits: 13

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