Member Forms

Forms may be downloaded by clicking the download links below. To request a hardcopy form, 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.

To use these forms you will need Adobe Reader®.  Information on completing forms with Reader®.  Forms using Adobe Reader can be printed, but cannot be saved electronically.

Digital Signature Forms through DocuSign: A number of forms are available for completion online with your digital signature and these forms are identified in the “Digital Signature Forms” column next to the form name. The form is completed, signed, and submitted electronically. You will have an option to save an electronic copy of any form you opt to fill out electronically and sign digitally.

Once you select the document, step-by-step directions are available within the DocuSign application.

Click here for more information on digital signatures

Digital Signature:

  • A digital signature means a computer-created electronic signature that is:
  • unique to the person using it;
  • intended by the person using it to have the same force and effect as the use of a manual signature;
  • 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 NumberForm NameDownload form as PDFRequest form via emailDigital Signature Forms
PackageService Retirement Application PackageDownload Package

Request Service Retirement Application Package
PackageRefund Application PackageDownload PackageRequest Refund Application Package
AC-0003Rollover / Direct Transfer Request / Certification Form (For purchase of service credit)Download AC-0003Request AC-0003
AC-0400Authorization Agreement for Electronic Direct DepositDownload AC-0400Request AC-0400
CL-0078Social Security Benefits and MainePERS BenefitsDownload CL-0078Request CL-0078
CL-0704Certificate of Teaching Service in Maine Public SchoolsDownload CL-0704Request CL-0704
CL-0704ACertificate of Teaching Service in Public or Private Academies, or Parochial SchoolsDownload CL-0704ARequest CL-0704A
CL-0704BCertificate of Out-of-State Teaching ServiceDownload CL-0704BRequest CL-0704B
CL-0715Application For Service Retirement BenefitsDownload CL-0715Request CL-0715
CL-0718Certification of Spousal NotificationDownload CL-0718Request CL-0718
CL-0722Pension Beneficiary Designation for Pre-Retirement Death Benefits
(Individuals completing this form might also consider completing the Designation of Beneficiary Group Life Insurance form.)
Download CL-0722Request CL-0722Download DocuSign Form CL-0722

CL-0722AInformation Regarding Pension Beneficiary Designation for Pre-Retirement Death BenefitsDownload CL-0722ARequest CL-0722A
CL-0875Certification of Nature of Termination Retirement Prior to Age 59-1/2 or Normal Retirement AgeDownload CL-0875

Request CL-0875
CL-0897Cost-of-Living Adjustment Election FormDownload CL-0897Request CL-0897
CL-0898Certificate of Service in Law EnforcementDownload CL-0898Request CL-0898
GU-1021Confidentiality Election Form - Home Contact InformationDownload GU-1021
Request GU-1021
H0027Additional Service Retirement InformationDownload Additional Service Retirement Informationn/a
H0046Service Retirement Application TimelineDownload Service Retirement Application Timelinen/a
H0051Alternate Payee Benefit Inception InformationDownload Alternate Payee Benefit Inception Informationn/a
MM-0002Member/Benefit Recipient Data UpdateDownload MM-0002Request MM-0002

Federal and State Withholding Forms

Form NumberForm NameDownload form as PDFRequest form via email
W-4PIRS-Withholding Certificate for Pension or Annuity PaymentsDownload W-4P

W-4MEState of Maine - Employees Withholding Allowance CertificateDownload W-4ME
CL-0905Non-Resident Certification for Maine Tax WithholdingDownload CL-0905

Request CL-0905
W-4RIRS-Withholding Certificate Nonperiodic Payments and Eligible Rollover Distributions. (This tax form is for Refunds and Rollover payments.)Download W-4R