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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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)


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)

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

Refund Forms

02-01 Refund of Accumulated Contributions (May, 2024)
02-02 Emergency Refund Request (May, 2024)
02-16 Request Research of Refundable Contributions (April, 2014)

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)