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

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

02-01A Authorization for Direct Rollover (August, 2020)
09-03 Request for Withdrawal from DROP-IBO (January, 2024)
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 Form
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 (February, 2021)
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 (May, 2024)
02-02 Emergency Refund Request (January, 2024)
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)