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.
To use these forms you will need Adobe Reader®. If you don’t have Reader, you can get it free by clicking the Adobe link above. For information on completing forms with Reader® click here.
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 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:
- 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 Number||Form Name||Download form as PDF||Request form via email||Digital Signature Forms|
|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-0722||Pension 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-0722||Request CL-0722||Download DocuSign Form CL-0722|
|CL-0722A||Information Regarding Pension Beneficiary Designation for Pre-Retirement Death Benefits||Download CL-0722A||Request CL-0722A|
|CL-0875||Certification of Nature of Termination Retirement Prior to Age 59-1/2 or Normal Retirement Age||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|
|GU-1021||Confidentiality Election Form - Home Contact Information||Download GU-1021||Request GU-1021|
|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||Request form via email|
|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|
|CL-0905||Non-Resident Certification for Maine Tax Withholding||Download CL-0905||Request CL-0905|