You are here:   Resources > 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.

Collapse All Expand All
1 Authorized Signatures and Employer Contacts (6/12) 
2 Enrollment Application/Employee Notification (Online)
2AC Change of Address Authorization (5/14)
2F  Forfeiture of Benefits Attestation (5/16)
2R  Election to Retain Membership (6/09)
2SS  Statement Concerning Your Employment in a Job Not Covered by Social Security (6/09) 
3 Named Beneficiary (2/20) 
4B  Contributions Correction Report (Online) 
4C  Contribution Payments Transmittal (Online) 
4P  Prior Year Correction of Earnings and Contributions (3/18)
W4P Withholding Certificate for Pension or Annuity Payments
4T  Employment Terminations (Online)
5  Service Credit Verification (1/13)
5PT  Report on Part-time Service (4/04)
5WC  Report on Workers' Compensation (4/04)
7  Application for Refund of Member Contributions (1/19)
7D  Application for Refund of Contributions to Beneficiary (4/16)
8 Authorization for Direct Deposit (12/19)
9 Application for Transfer or Reciprocal Recognition of Service (4/17)
9A Application for Purchase of Service (2/17)
9RO  Rollover/Trustee-to-Trustee Transfer Acceptance (3/15)
10  Application for Service Retirement, IBRP, or DROP (11/19)
10A  Employer Certification (5/11)
10C   Application for Retirement After DROP (11/19) 
11 Spousal_Consent_DROP_IBRP_Account (12/19)
12  Application for Disability Retirement (6/17)
12B Supervisor Statement of Disability (6/17)
12C Physician Report of Disability (6/17)
13 Application for Survivor Benefit (5/17)
13B Student Certification (9/19)
13C Under Revision
15 Re-employment of Retiree - Earnings Report (Online)
15N  Retiree Return-to-Work Notification (Online)
16  Request for Monthly Benefit Estimate (9/14)
18 Member Authorization for Income Verification (1/12) 
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