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.
Forms cannot be saved or altered.
New: A number of forms are now also available for completion online with your digital signature. We refer to these forms as “Digital Signature Forms.” You do not need to print paper to fill out and submit “Digital Signature Forms.” You do not need to print paper to fill out and submit “Digital Signature Forms.” You will have an option to save an electronic copy of any form you opt to fill out electronically and sign digitally.
The Digital Signature Forms are being made available through “Carahsoft OBO Maine Public Employees Retirement System (MainePERS)” using the DocuSign Platform. These forms are located in the table below.
To select and complete an available digital signature form, click on the link in the box under the “Digital Signature Forms” column for that form. Step-by-step directions are available within the form signing process itself.
Click here for more information on digital signatures
A digital signature means a computer-created electronic signature that is:
- intended by the person using it to have the same force and effect as the use of a manual signature;
- unique to the person using it;
- capable of verification;
- under the sole control of the person using it; and
- linked to data in such a manner that it is invalidated if changes are made to the data.
Digital signatures require creation by specialized software platforms.
|Form Number||Form Name||Download form as PDF||Request form via email||Digital Signature Forms|
|Package||Service Retirement Application Package||Download Package||Request Package|
|AC-1181||Authorization Agreement for Preauthorized ACH Debits - MaineSTART||n/a||Request AC-1181|
|AC-1182||Authorization Agreement for Preauthorized ACH Credits -DB and GLI Plans||n/a||Request AC-1182|
|AC-1184||Authorization Agreement for Preauthorized ACH Credits - MaineSTART||n/a||Request AC-1184|
|CL-0722||Designation of Beneficiary Pre-Retirement Death Benefits|
(Individuals completing this form might also consider completing the Change of Beneficiary Group Life Insurance form.)
|Download CL-0722||Request CL-0722||Download DocuSign Form CL-0722
|EM-0003A||MainePERS Employer Security Administrator Authorization||n/a||Request EM-0003A|
|EM-0003D||Employer Self Service Security Administrator Designation Form||n/a||Request EM-0003D|
|EM-0005||Annual Employer Self Service (ESS) Security Compliance Certification||Download EM-0005||Request EM-0005|
|GI-0874||Request for Basic and/or Additional Insurance Coverage Requiring Evidence of Insurability||Download GI-0874||Request GI-0874||Download DocuSign Form GI-0874|
|CL-0722A||Information Regarding Designation of Beneficiary Pre-Retirement Death Benefits||Download CL-0722A||Request CL-0722A|
|GI-0880||Dependent Insurance||Download GI-0880||Request GI-0880|
|GI-0881||Cancellation/Reduction in Coverage||Download GI-0881||Request GI-0881|
|GI-0912||Designation of Beneficiary - Group Life Insurance|
(Individuals completing this form might also consider completing the Designation of Beneficiary Pre-Retirement Death Benefits form.)
|Download GI-0912||Request GI-0912||Download DocuSign Form GI-0912|
|GU-1016||Payment or Award at Retirement Certification Form||Download GU-1016||Request GU-1016|
|GU-1021||Confidentiality Election Form - Home Contact Information||Download GU-1021||Request GU-1021|
|MM-0002||Member/Benefit Recipient Data Update||Download MM-0002||Request MM-0002|
|SSA-1945||Statement Concerning Your Employment in a Job Not Covered by Social Security||Download SSA-1945||Request SSA-1945|