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Employee Forms

Whether you're naming a beneficiary, updating your address, applying for retirement or much more, you'll find all our Employee Forms here. Click the links on the left to view the forms specific to your MERS program. To view a list of all our MERS forms, click here.

Form #

Name

Product

Audience

5	Membership Application	Defined Benefit	Employer, Employee
21	Beneficiary Change Request	Defined Benefit	Employee
24	Refund Application	Defined Benefit	Employee
25	MERS Safe Harbor Explanation	Defined Benefit	Employee
26	Refund Application for Deceased Member's Contributions	Defined Benefit	Employee
27	Verification for the Crediting of Other Governmental Service	Defined Benefit	Employee
28	Application for Deferred Service Status	Defined Benefit	Employee
29a	Application for Service Retirement	Defined Benefit	Employee
29b	Employer's Certification of Termination of Employment for Retiring Member	Defined Benefit	Employee
29C	Dual Certification For Re-Employed Retiree	Defined Benefit	Employee
29D	Dual Certification For Voter-Elected Or Appointed Official Who Retired From And Is Re-Employed By The Same Municipality	Defined Benefit	Employee
30	Election of Retirement Allowance Option	Defined Benefit	Employee
31b	Withholding Certificate for Michigan Pension or Annuity Payments	Defined Benefit, Hybrid, Defined Contribution	Retiree
32	Application for Retirement Allowance by Surviving Spouse or Child	Defined Benefit	Employee
33	Statement of Contingent Survivor Beneficiary	Defined Benefit	Employee
34	Statement of Beneficiary	Defined Benefit	Employee
35A	Standard Participant Transfer Rules	Defined Benefit	Employee
35B	Standard Transfer Member Certification for Same Employer	Defined Benefit	Employee
35C	Alternative Transfer Member Certification for Same Employer	Defined Benefit	Employee
36	Electronic Funds Transfer – Direct Deposit Authorization	Defined Benefit	Employee
37	Stop Payment Request	Defined Benefit	Employee
38	Certification of Qualified Fund Rollover to MERS (General) with Instructions	Defined Benefit	Employee
41	Option IV Beneficiary Change Request	Defined Benefit	Employee
42	DROP+ and Election	Defined Benefit	Employee
46	Affidavit Affirming Existence of Insurable Interest	Defined Benefit	Employee
51	Application for Disability Retirement	Defined Benefit, Disability	Employer, Employee
52	Limitation on Disability Benefits – Affidavit	Defined Benefit Plan	Employee
53	Physician's Statement	Defined Benefit, Disability	Employer, Employee
54	Psychiatric Medical Report	Defined Benefit, Disability	Employer, Employee
71	MERS Model DRO for Defined Benefit	Defined Benefit	Employee
72	MERS Model EDRO for Defined Benefit	Defined Benefit	Employee
75	MERS Model DRO for Defined Contribution	Defined Contribution	Employee
76	MERS Participating Municipalities	Defined Benefit, Defined Contribution, Hybrid	Employer, Employee
77	Reciprocal Retirement Act (“Act 88”) - Adopting Units	Defined Benefit, Defined Contribution, Hybrid	Employer, Employee
78	MERS Model DRO for HCSP	Health Care Savings Program	Employee
MD-001	Personal Information	Defined Benefit, Defined Contribution, Health Care Savings Program, 457, Hybrid	Employee
MD-002	Payroll/Investment Election	Defined Contribution	Employee
MD-003	Beneficiary Designation	Defined Contribution	Employee
MD-004	Incoming Direct Rollover	Defined Contribution	Employee
MD-005	Distribution/Direct Rollover	Defined Contribution	Employee
MD-006	Spousal Beneficiary Claim Request	Defined Contribution	Employee
MD-007	Non-Spousal Beneficiary Claim Request	Defined Contribution	Employee
MD-008	In-Service Withdrawal Request	Defined Contribution	Employee
MD-009	Required Minimum Distribution Request	Defined Contribution	Employee
MD-010	Loan Application	Defined Contribution	Employee
MD-102	HCSP Investment Election	Health Care Savings Program	Employee
MD-103	HCSP Beneficiary Designation	Health Care Savings Program	Employee
MD-302	Payroll/Investment Election	Hybrid	Employee
MD-303	Beneficiary Designation	Hybrid	Employee
MD-304	Incoming Direct Rollover	Hybrid	Employee
MD-402	Payroll/Investment Election	457	Employee
MD-403	Beneficiary Designation	457	Employee
MD-404	Incoming Direct Rollover	457	Employee
MD-405	Distribution/Direct Rollover	457	Employee
MD-406	Spousal Beneficiary Claim Request	457	Employee
MD-407	Non-Spousal Beneficiary Claim Request	457	Employee
MD-408	In-Service Withdrawal Request	457	Employee
MD-409	Required Minimum Distribution Request	457	Employee
MD-410	Loan Application	457	Employee
MD-412	Unforeseeable Emergency Withdrawals	457	Employee
MD-414	Contribution Catch Up	457	Employee
MD-415	Opt Out Refund	457	Employee
2527	Request for Absolute Assignment and Successor Owner Endorsement	Stable Income Annuity	Employee
5031	Substitute IRS Forms W-4P and W-9	Stable Income Annuity	Employee
8513	Immediate Annuity Application	Stable Income Annuity	Employee
6146	Statement of Beneficiary Claim to Benefits	Stable Income Annuity	Employee
6304	Request for Change of Beneficiary	Stable Income Annuity	Employee
6614	Request for Contract Application Amendment	Stable Income Annuity	Employee
11426	Request for EFT of Annuity Payout	Stable Income Annuity	Employee
11436	Request for Change of EFT Annuity Payout	Stable Income Annuity	Employee
12213	Request For Rollover, Transfer or Exchange	Stable Income Annuity	Employee
12216	Acknowledgement of Suitability in an Annuity Purchase	Stable Income Annuity	Employee
12428	Request for Change to Annuity Policy	Stable Income Annuity	Employee
13018	Qualified Joint and Survivor Annuity Notice and Spousal Consent	Stable Income Annuity	Employee
13469	Stable Income Annuity Disclosure	Stable Income Annuity	Employee