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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.

1Authorized Signatures and Employer Contacts (Online)
2Enrollment Application/Employee Notification (Online)
2AC Change of Address Authorization
2FForfeiture of Benefits Attestation
2RElection to Retain Membership
2SSStatement Concerning Your Employment in a Job Not Covered by Social Security
3Named Beneficiary
4BContributions Correction Report (Online)
4CContribution Payments Transmittal (Online)
4PPrior Year Correction of Earnings and Contributions
W4P  Withholding Certificate for Pension or Annuity Payments
4TEmployment Terminations (Online)
5Service Credit Verification
5PTReport on Part-time Service
5WCReport on Workers’ Compensation
7Application for Refund of Member Contributions
7DApplication for Refund of Contributions to Beneficiary
8Authorization for Direct Deposit
9Application for Transfer or Reciprocal Recognition of Service
9AApplication for Purchase of Service
9RORollover/Trustee-to-Trustee Transfer Acceptance
10Application for Service Retirement, IBRP, or DROP
10AEmployer Certification
10CApplication for Retirement After DROP
11Spousal Consent DROP IBRP Account
12Application for Disability Retirement
12BSupervisor Statement of Disability
12CPhysician Report of Disability
13Application for Survivor Benefit
13BStudent Certification
13CCertificate of Heirship
15Re-employment of Retiree – Earnings Report (Online)
15NRetiree Return-to-Work Notification (Online)
16Request for Monthly Benefit Estimate
18Member 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: 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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