Member Forms
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 |
---|---|---|---|
Package | Service Retirement Application Package | Download Package | Request Service Retirement Application Package |
Package | Refund Application Package | Download Package | Request Refund Application Package |
AC-0003 | Rollover / Direct Transfer Request / Certification Form (For purchase of service credit) | Download AC-0003 | Request AC-0003 |
AC-0400 | Authorization Agreement for Electronic Direct Deposit | Download AC-0400 | Request AC-0400 |
CL-0078 | Social Security Benefits and MainePERS Benefits | Download CL-0078 | Request CL-0078 |
CL-0704 | Certificate of Teaching Service in Maine Public Schools | Download CL-0704 | Request CL-0704 |
CL-0704A | Certificate of Teaching Service in Public or Private Academies, or Parochial Schools | Download CL-0704A | Request CL-0704A |
CL-0704B | Certificate of Out-of-State Teaching Service | Download CL-0704B | Request CL-0704B |
CL-0715 | Application For Service Retirement Benefits | Download CL-0715 | Request CL-0715 |
CL-0718 | Certification of Spousal Notification | Download CL-0718 | Request CL-0718 |
CL-0719 | Information Regarding Restoration to Service (Election Form) for PLDs with Social Security | Download CL-0719 | Request CL-0719 |
CL-0722 | Designation of Beneficiary Pre-Retirement Death Benefits (Individuals completing this form might also consider completing the Designation of Beneficiary Group Life Insurance form.) | Download CL-0722 | Request CL-0722 |
CL-0722A | Information Regarding Designation of Beneficiary Pre-Retirement Death Benefits | Download CL-0722A | Request CL-0722A |
CL-0875 | Certification of Bona Fide Termination | Download CL-0875 | Request CL-0875 |
CL-0897 | Cost-of-Living Adjustment Election Form | Download CL-0897 | Request CL-0897 |
CL-0898 | Certificate of Service in Law Enforcement | Download CL-0898 | Request CL-0898 |
H0027 | Additional Service Retirement Information | Download Additional Service Retirement Information | n/a |
H0046 | Service Retirement Application Timeline | Download Service Retirement Application Timeline | n/a |
H0051 | Alternate Payee Benefit Inception Information | Download Alternate Payee Benefit Inception Information | n/a |
MM-0002 | Member/Benefit Recipient Data Update | Download MM-0002 | Request MM-0002 |
Federal and State Withholding Forms
Form Number | Form Name | Download form as PDF |
---|---|---|
W-4P | IRS-Withholding Certificate for Pension or Annuity Payments | Download W-4P |
W-4ME | State of Maine - Employees Witholding Allowance Certificate | Download W-4ME |