Retirement Benefits Forms

Forms - Retirement Benefits

Forms may be downloaded by clicking the corresponding form number below. The "Request Forms" e-mail is for ordering hardcopy forms only. For all other inquiries, please contact MainePERS directly.

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CL-0715⁺	Application For Service Retirement Benefits	Request Form
H0027	Additional Service Retirement Information
AC-0400	Authorization Agreement for Electronic Direct Deposit	Request Form
CL-0875+	Certification of Bona Fide Termination	Request Form
CL-0704B	Certificate of Out-of-State Teaching Service	Request Form
CL-0718+	Certification of Spousal Notification	Request Form
CL-0704	Certificate of Teaching Service in Maine Public Schools	Request Form
CL-0704A	Certificate of Teaching Service in Public or Private Academies, or Parochial Schools	Request Form
CL-0055	Employer Preliminary Benefit Certification Form	Request Form
CL-0719	Information Regarding Restoration to Service (Election Form) for PLDs with Social Security	Request Form
CL-0863S	Informed Consent to Revision of Beneficiary Designation	Request Form
GU-1016	Payment or Award at Retirement Certification Form	Request Form
AC-0003⁺	Rollover / Direct Transfer Request / Certification Form (For purchase of service credit)	Request Form
Package	Service Retirement Application Package	Request Package
CL-0078	Social Security Benefits and the MainePERS Benefits	Request Form
H0032	Taxes and Your First Benefit Payment
CL-0051	Vacation and Sick Leave Reporting Form for PLD Members (Click here for instructions)	Request Form
CL-0052	Vacation and Sick Leave Reporting Form for State Members (Click here for instructions)	Request Form
CL-0050	Vacation and Sick Leave Reporting Form for Teacher Members (Click here for instructions)	Request Form

H0019	How the Taxable Portion of Your Service Retirement Benefit is Determined
W-4P	Withholding Certificate for Pension or Annuity Payments
W-4ME	Employees Maine Withholding Allowance Certificate

+ Forms indicated with "+" may be viewed and completed on the screen using a recent version of Adobe^® Reader^®, printed, and mailed to the MainePERS. You may click on any line to complete that area or use TAB to move forward and SHIFT-TAB to move back. Forms cannot be saved or altered.