New PERAC Forms

We have released updated versions of several retirement forms.

The following forms were added to the website in February

Beneficiary Forms

• Application for Member Survivor Benefits
• Beneficiary Change Form
• Beneficiary Selection Form
• Beneficiary Selection Form (Option D form) (Option D)
  This is a new form!
• Notice of Election of Benefits under 12(2)(d)
• Retirement Option Selection Form
• Spousal Affidavit to Determine Benefit Eligibility

Disability Forms

• Disability Retirement Application
• Involuntary Retirement Application
• Authorization to Use or Disclose Protected Health Information
  This form is included in the Application for Disability Retirement
• Physician's Statement Pertaining to a Member's Disability Retirement Application
• Regional Medical Panel Certificate
  This form replaces the three presumptions certificates
  A fillable version is available in the PROSPER application

Employer Forms

• Employer's Shift Substitution Certification
• Employer Statement for Disability Retirement Application

General Membership Forms

• Retirement Application (voluntary superannuation)
• Refund Application
• New Member Enrollment Form
• Special Tax Notice Regarding Lump Sum Distributions
• Veterans' Buyback Form

Additional Resources

PERAC Forms and Publications