Forms may be downloaded by clicking the download links below. To request hardcopy forms, please send an email request via the link in the “Request form via email” column next to the form name. For all other inquiries, please contact MainePERS directly.
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Forms cannot be saved or altered.
|Form Number||Form Name||Download form as PDF||Request form via email|
|ASC Package||Annual Statement of Compensation Information Package||Download Package||Request Annual Statement of Compensation Information Package|
|Review Package||Review for Continuing Disability Information Package||Download Review for Continuing Disability Information Package||n/a|
|CL-0724||Prospective Beneficiary of Member Changing to Service Retirement||Download CL-0724||Request CL-0724|
|CL-0875||Certification of Bona Fide Termination||Download CL-0875||Request CL-0875|
|CL-0888||Consent Form Designating Authorized Representatives||Download CL-0888||Request CL-0888|
|CL-0888A||Consent Form Designating Authorized Representatives||Download CL-0888A||n/a|
|DC-0003a||Addendum to Application for Disability Retirement Benefits||Download DC-0003a||Request DC-0003a|
|DC-0005||Report of Continuing Disability||Download DC-005||n/a|
|DC-0007||Release of Information to Rehabilitation Providers||Download DC-0007||Request DC-0007|
|DC-0008||Employment Contact Form||Download DC-0008||Request DC-0008|
|DC-0013S||Application for Survivor Benefits||Download DC-0013S SAMPLE||Request DC-0013s|
|DC-0013A||Addendum to Application for Survivor Benefits||Download DC-0013A SAMPLE||Request DC-0013A|
|DC-0482||2019 Annual Statement of Compensation||Download DC-0482||Request DC-0482|
|DC-0514||Medical Certification for Disability Recipients||Download DC-0514||n/a|
|DC-0603||Consent Form Authorizing Release of Information||Download DC-0603||Request DC-0603|
|DC-0603A||Consent Form Authorizing Release of Information||Download DC-0603A||n/a|
|FS1120||Earnings Limitations for Disability Retirement Recipients||Download FS1120||Request DC-0603|