MEMBER FORMS
NEW! Select Forms Available to Submit Electronically
- Application for Repayment of Refunded Service
- Authorization for Direct Deposit
- Designation of Beneficiary
- Refund of Accumulated Contributions
- Request for First Eligible Letter for Social Security
- Request for Retirement Benefits Estimate
- Request for Withdrawal from DROP-IBO Account (for DROP accounts at LASERS)
- W-4P Withholding Certificate for Periodic Pension or Annuity Payments
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| Disability Forms | |
|---|---|
| 04-01 | Disability Retirement Application (June 2023) |
| 04-01C | Certification of Disability Sustained from an Intentional Act of Violence (June 2021) |
| 04-03 | Disability Retiree Earned Income Statement (August 2020) |
| 04-08 | Disability to Regular Retirement Election (March 2020) |
| MSD12 | Attending Physician’s Statement (March 2023) |
| MSD46 | Disability Appeal (September 2013) |
| DROP/IBO Forms | |
|---|---|
| 02-01A | Authorization for Direct Rollover (August 2020) |
| 09-03 | Request for Withdrawal from DROP-IBO (April 2026) For retired members with a DROP/IBO account held at LASERS. |
| 09-04 | Transfer to Self-Directed Plan (October 2010) |
| Legal Forms | |
|---|---|
| 04-04 | Spousal Consent (May 2024) |
| 04-07 | Affidavit of Suspension of Benefits (August 2014) |
| Legal | Married Members with Separate Property Agreements (March 2009) |
| Legal | Limited Power of Attorney |
| Legal | Division of LASERS Benefits (Sample Domestic Relations Order, addendum and synopsis) |
| Legal | Sample Motion and Order – Move to Maximum Due to Divorce |
| MSD50 | Request for Return of Legal Documents Submitted to LASERS (April 2015) |
| MSD61 | Affidavit of Natural Tutorship of Minor Child |
| MSD62 | Affidavit of Natural Tutorship of Disabled Child |
| Member Demographics/Member Information | |
|---|---|
| 01-02 | Contact Information Update (September 2024) |
| 01-06 | Designation of Beneficiary (October 2018) |
| 01-07 | Change of Name (April 2020) |
| 04-05 | Authorization for Direct Deposit (February 2023) |
| 04-06 | Application for Waiver of Electronic Funds Transfer Requirement (August 2020) |
| W-4P | Withholding Certificate for Pension or Annuity Payments |
| Purchases and Transfers of Service | |
|---|---|
| 02-03 | Application for Reciprocal Recognition of Service (October 2017) |
| 02-04 | Application for Transfer and/or Upgrade of Creditable Service (December 2023) |
| 02-06 | Application for Purchase of Military Service (December 2023) |
| 02-07 | Application for Purchase of Service R.S. 11 429 (B) (December 2023) |
| 02-11 | Application for Repayment of Refunded Service (December 2023) |
| 02-12 | Application for Repayment of Refunded Service to Reciprocate/Transfer (December 2023) |
| 02-13 | LASERS Acceptance Letter of Rollover Assets (March 2023) |
| 02-15 | Judicial Upgrade Invoice Request (December 2023) |
| 02-20 | Application for Purchase of Federal Service (December 2023) |
| 15-01A | ORP Defined Contribution Plan Transfer to LASERS Defined Benefit Plan (December 2023) |
| Refund Forms | |
|---|---|
| 02-01 | Refund of Accumulated Contributions (April 2026) For members who have separated/terminated from state service. |
| 02-02 | Emergency Refund Request (April 2026) |
| 02-16 | Request Research of Refundable Contributions (April 2014) |
| Requests | |
|---|---|
| 05-01 | Request for Retirement Benefit Estimate (May 2021) |
| 06-03 | Option 2B Mentally Handicapped Designee (August 2010) |
| 10-06 | Application for Change in Retirement Benefit Due to Divorce (December 2023) |
| 10-07 | Application for Change in Retirement Benefit Due to Death of Beneficiary (April 2020) |
| MSD32 | Request for Contribution Income Verification (August 2015) |
| MSD33 | Request for First Eligible Letter for Social Security (August 2015) |
| MSD41 | Visitor Information Sheet (April 2024) |
| Survivor Benefits | |
|---|---|
| 03-02 | Spouse and Adult Child Selection of Distribution (June 2023) |
| 03-03 | Survivor Marital Status Update (March 2012) |
| 10-01 | Beneficiary Signature (April 2020) |