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Thursday, August 25, 2016
MERS Forms

Employee Forms

Whether you're naming a beneficiary, updating your address, applying for retirement or much more, you'll find all our Employee Forms here. Click the links on the left to view the forms specific to your MERS program. To view a list of all our MERS forms, click here.

Form # Name Product Audience Online Info
5 Defined Benefit Membership Application Defined Benefit Employer, Employee more information

Defined Benefit Membership Application

Form #: 5

Product: Defined Benefit
Audience: Employer, Employee

10 Transfer Of Contributions Within MERS Defined Benefit Plan (excluding Hybrid Benefit Program DB Component) Defined Benefit Employee more information
21 Defined Benefit Beneficiary Change Request Form Defined Benefit Employee more information

Defined Benefit Beneficiary Change Request Form

Form #: 21

Product: Defined Benefit
Audience: Employee

24 Refund Application Defined Benefit Employee more information

Refund Application

Form #: 24

Product: Defined Benefit
Audience: Employee

25 Special Tax Notice ("Safe Harbor" Explanation) Defined Benefit Employee more information

Special Tax Notice ("Safe Harbor" Explanation)

Form #: 25

Product: Defined Benefit
Audience: Employee

26 Refund Application for Deceased Member's Contributions Defined Benefit Employee more information

Refund Application for Deceased Member's Contributions

Form #: 26

Product: Defined Benefit
Audience: Employee

27 Verification for the Crediting of Other Governmental Service Defined Benefit; Defined Contribution, Hybrid Employee more information

Verification for the Crediting of Other Governmental Service

Form #: 27

Product: Defined Benefit; Defined Contribution, Hybrid
Audience: Employee

29 Application for Defined Benefit Retirement Defined Benefit Employee more information

Application for Defined Benefit Retirement

Form #: 29

Product: Defined Benefit
Audience: Employee

F-29c Working in Retirement Certification Defined Benefit, Hybrid Employee more information

Working in Retirement Certification

Form #: F-29c

Product: Defined Benefit, Hybrid
Audience: Employee

31 Pension Recipient's Federal Income Tax Withholding Authorization Defined Benefit, Hybrid Employee, Retiree more information

Pension Recipient's Federal Income Tax Withholding Authorization

Form #: 31

Product: Defined Benefit, Hybrid
Audience: Employee, Retiree

F-31b Withholding Certificate for Michigan Pension or Annuity Payments Defined Benefit, Hybrid, Defined Contribution Employee False more information

Withholding Certificate for Michigan Pension or Annuity Payments

Form #: F-31b

Product: Defined Benefit, Hybrid, Defined Contribution
Audience: Employee

F-32 Defined Benefit Survivor Beneficiary Application Defined Benefit, Hybrid Employee False more information

Defined Benefit Survivor Beneficiary Application

Form #: F-32

Product: Defined Benefit, Hybrid
Audience: Employee

35B Standard Transfer Member Certification for Same Employer Defined Benefit Employee more information

Standard Transfer Member Certification for Same Employer

Form #: 35B

Product: Defined Benefit
Audience: Employee

35C Alternative Transfer Member Certification for Same Employer Defined Benefit Employee more information

Alternative Transfer Member Certification for Same Employer

Form #: 35C

Product: Defined Benefit
Audience: Employee

F-36 Electronic Funds Transfer – Direct Deposit Authorization Defined Benefit, Hybrid Employee more information

Electronic Funds Transfer – Direct Deposit Authorization

Form #: F-36

Product: Defined Benefit, Hybrid
Audience: Employee

37 Stop Payment Request Defined Benefit Employee more information

Stop Payment Request

Form #: 37

Product: Defined Benefit
Audience: Employee

F-38 Certification of Qualified Fund Rollover to MERS Defined Benefit Employee more information

Certification of Qualified Fund Rollover to MERS

Form #: F-38

Product: Defined Benefit
Audience: Employee

41 Option IV Beneficiary Change Request Defined Benefit Employee more information

Option IV Beneficiary Change Request

Form #: 41

Product: Defined Benefit
Audience: Employee

42 DROP+ and Election Defined Benefit Employee more information

DROP+ and Election

Form #: 42

Product: Defined Benefit
Audience: Employee

F-48 Alternate Payee (Former Spouse) Benefit Application Defined Benefit Participant more information

Alternate Payee (Former Spouse) Benefit Application

Form #: F-48

Product: Defined Benefit
Audience: Participant

F-50 Informed Consent and Authorization: Application for Disability Retirement Defined Benefit; Hybrid Employee more information

Informed Consent and Authorization: Application for Disability Retirement

Form #: F-50

Product: Defined Benefit; Hybrid
Audience: Employee

51 Application for Disability Retirement Defined Benefit, Disability Employer, Employee more information

Application for Disability Retirement

Form #: 51

Product: Defined Benefit, Disability
Audience: Employer, Employee

52 Limitation on Disability Benefits – Affidavit Defined Benefit Plan Employee more information

Limitation on Disability Benefits – Affidavit

Form #: 52

Product: Defined Benefit Plan
Audience: Employee

F-53 Physician's Statement of Disability Defined Benefit, Disability Employer, Employee more information

Physician's Statement of Disability

Form #: F-53

Product: Defined Benefit, Disability
Audience: Employer, Employee

54 Psychiatric Medical Report Defined Benefit, Disability Employer, Employee more information

Psychiatric Medical Report

Form #: 54

Product: Defined Benefit, Disability
Audience: Employer, Employee

N/A Domestic Relations Order Qualification Fee Policy Defined Benefit, Defined Contribution, Hybrid, Health Care Savings Program, 457 Employee more information

Domestic Relations Order Qualification Fee Policy

Form #: N/A

Product: Defined Benefit, Defined Contribution, Hybrid, Health Care Savings Program, 457
Audience: Employee

71 MERS Model DRO for Defined Benefit Defined Benefit Employee more information

MERS Model DRO for Defined Benefit

Form #: 71

Product: Defined Benefit
Audience: Employee

72 MERS Model EDRO for Defined Benefit Defined Benefit Employee more information

MERS Model EDRO for Defined Benefit

Form #: 72

Product: Defined Benefit
Audience: Employee

72b MERS Procedure for Reviewing and Qualifying Eligible Domestic Relations Orders Defined Benefit Employee more information

MERS Procedure for Reviewing and Qualifying Eligible Domestic Relations Orders

Form #: 72b

Product: Defined Benefit
Audience: Employee

75 MERS Model DRO for Defined Contribution Defined Contribution Employee more information

MERS Model DRO for Defined Contribution

Form #: 75

Product: Defined Contribution
Audience: Employee

77 Reciprocal Retirement Act (“Act 88”) - Adopting Units Defined Benefit, Defined Contribution, Hybrid Employer, Employee more information

Reciprocal Retirement Act (“Act 88”) - Adopting Units

Form #: 77

Product: Defined Benefit, Defined Contribution, Hybrid
Audience: Employer, Employee

78 MERS Model DRO for HCSP Health Care Savings Program Employee more information

MERS Model DRO for HCSP

Form #: 78

Product: Health Care Savings Program
Audience: Employee

MD-000 Defined Contribution Enrollment Kit Defined Contribution Employer, Employee more information

Defined Contribution Enrollment Kit

Form #: MD-000

Product: Defined Contribution
Audience: Employer, Employee

MD-001 Personal Information Defined Benefit, Defined Contribution, Health Care Savings Program, 457, Hybrid Employee more information

Personal Information

Form #: MD-001

Product: Defined Benefit, Defined Contribution, Health Care Savings Program, 457, Hybrid
Audience: Employee

MD-002 Defined Contribution Investment Change Defined Contribution Employee more information

Defined Contribution Investment Change

Form #: MD-002

Product: Defined Contribution
Audience: Employee

MD-102 Health Care Savings Program Investment Change Health Care Savings Program Employee more information

Health Care Savings Program Investment Change

Form #: MD-102

Product: Health Care Savings Program
Audience: Employee

MD-003 Beneficiary Designation Defined Contribution Employee more information

Beneficiary Designation

Form #: MD-003

Product: Defined Contribution
Audience: Employee

MD-004 Incoming Direct Rollover Defined Contribution Employee more information

Incoming Direct Rollover

Form #: MD-004

Product: Defined Contribution
Audience: Employee

MD-005 Distribution/Direct Rollover Defined Contribution Employee more information

Distribution/Direct Rollover

Form #: MD-005

Product: Defined Contribution
Audience: Employee

MD-006 Spousal Beneficiary Claim Request Defined Contribution Employee more information

Spousal Beneficiary Claim Request

Form #: MD-006

Product: Defined Contribution
Audience: Employee

MD-007 Non-Spousal Beneficiary Claim Request Defined Contribution Employee more information

Non-Spousal Beneficiary Claim Request

Form #: MD-007

Product: Defined Contribution
Audience: Employee

MD-008 In-Service Withdrawal Request Defined Contribution Employee more information

In-Service Withdrawal Request

Form #: MD-008

Product: Defined Contribution
Audience: Employee

MD-009 Required Minimum Distribution Request Defined Contribution Employee more information

Required Minimum Distribution Request

Form #: MD-009

Product: Defined Contribution
Audience: Employee

MD-010 Defined Contribution Loan Application Defined Contribution Employee more information

Defined Contribution Loan Application

Form #: MD-010

Product: Defined Contribution
Audience: Employee

MD-016 MERS-to-MERS Service Verification Form Defined Contribution Employee False more information

MERS-to-MERS Service Verification Form

Form #: MD-016

Product: Defined Contribution
Audience: Employee

MD-103 HCSP Beneficiary Designation Health Care Savings Program Employee more information

HCSP Beneficiary Designation

Form #: MD-103

Product: Health Care Savings Program
Audience: Employee

MD-303 Beneficiary Designation Hybrid Employee more information

Beneficiary Designation

Form #: MD-303

Product: Hybrid
Audience: Employee

MD-304 Incoming Direct Rollover Hybrid Employee more information

Incoming Direct Rollover

Form #: MD-304

Product: Hybrid
Audience: Employee

MD-400 457 Program Enrollment Kit 457 Employer, Employee more information

457 Program Enrollment Kit

Form #: MD-400

Product: 457
Audience: Employer, Employee

MD-402 457 Investment Change 457 Participant more information

457 Investment Change

Form #: MD-402

Product: 457
Audience: Participant

MD-403 Beneficiary Designation 457 Employee more information

Beneficiary Designation

Form #: MD-403

Product: 457
Audience: Employee

MD-404 Incoming Direct Rollover 457 Employee more information

Incoming Direct Rollover

Form #: MD-404

Product: 457
Audience: Employee

MD-405 Distribution/Direct Rollover 457 Employee more information

Distribution/Direct Rollover

Form #: MD-405

Product: 457
Audience: Employee

MD-406 Spousal Beneficiary Claim Request 457 Employee more information

Spousal Beneficiary Claim Request

Form #: MD-406

Product: 457
Audience: Employee

MD-407 Non-Spousal Beneficiary Claim Request 457 Employee more information

Non-Spousal Beneficiary Claim Request

Form #: MD-407

Product: 457
Audience: Employee

MD-408 In-Service Withdrawal Request 457 Employee more information

In-Service Withdrawal Request

Form #: MD-408

Product: 457
Audience: Employee

MD-409 Required Minimum Distribution Request 457 Employee more information

Required Minimum Distribution Request

Form #: MD-409

Product: 457
Audience: Employee

MD-410 Loan Application 457 Employee more information

Loan Application

Form #: MD-410

Product: 457
Audience: Employee

MD-412 Unforeseeable Emergency Withdrawals 457 Employee more information

Unforeseeable Emergency Withdrawals

Form #: MD-412

Product: 457
Audience: Employee

MD-414 Contribution Catch Up 457 Employee more information

Contribution Catch Up

Form #: MD-414

Product: 457
Audience: Employee

MD-415 Opt Out Refund 457 Employee more information

Opt Out Refund

Form #: MD-415

Product: 457
Audience: Employee

2527 Request for Absolute Assignment and Successor Owner Endorsement Stable Income Annuity Employee more information

Request for Absolute Assignment and Successor Owner Endorsement

Form #: 2527

Product: Stable Income Annuity
Audience: Employee

8513 Stable Income Annuity Adoption Packet Stable Income Annuity Employee more information

Stable Income Annuity Adoption Packet

Form #: 8513

Product: Stable Income Annuity
Audience: Employee

12999 Stable Income Annuity Disclosure Stable Income Annuity Member more information

Stable Income Annuity Disclosure

Form #: 12999

Product: Stable Income Annuity
Audience: Member

6146 Statement of Beneficiary Claim to Benefits Stable Income Annuity Employee more information

Statement of Beneficiary Claim to Benefits

Form #: 6146

Product: Stable Income Annuity
Audience: Employee

6304 Request for Change of Beneficiary Stable Income Annuity Employee more information

Request for Change of Beneficiary

Form #: 6304

Product: Stable Income Annuity
Audience: Employee

6614 Request for Contract Application Amendment Stable Income Annuity Employee more information

Request for Contract Application Amendment

Form #: 6614

Product: Stable Income Annuity
Audience: Employee

11436 Request for Change of EFT Annuity Payout Stable Income Annuity Employee more information

Request for Change of EFT Annuity Payout

Form #: 11436

Product: Stable Income Annuity
Audience: Employee

12428 Request for Change to Annuity Policy Stable Income Annuity Employee more information

Request for Change to Annuity Policy

Form #: 12428

Product: Stable Income Annuity
Audience: Employee

13018 Qualified Joint and Survivor Annuity Notice and Spousal Consent Stable Income Annuity Employee more information

Qualified Joint and Survivor Annuity Notice and Spousal Consent

Form #: 13018

Product: Stable Income Annuity
Audience: Employee

MD-300 Hybrid Enrollment Kit Hybrid Employer, Employee more information

Hybrid Enrollment Kit

Form #: MD-300

Product: Hybrid
Audience: Employer, Employee

MD-100 Health Care Savings Program Enrollment Kit Health Care Savings Program Employer, Employee more information

Health Care Savings Program Enrollment Kit

Form #: MD-100

Product: Health Care Savings Program
Audience: Employer, Employee

73 MERS Model DRO for 457 Plan 457 Employee more information

MERS Model DRO for 457 Plan

Form #: 73

Product: 457
Audience: Employee

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Disclaimer
The information contained in this Web site is being made available as a public service. The information is not intended to constitute legal or investment advice, or to replace official versions of that information. Benefit Estimates or Service Credit Purchase estimates requested through this Web site are not official descriptions of any benefits, and do not represent a promise by MERS to provide any benefit(s) to any person(s). No one can detrimentally rely upon the information provided in, or requested through this Web site. MERS reserves the right to correct any errors, and presents this information without warranties, express or implied, regarding the information?s accuracy, timeliness or completeness. If you believe the information is inaccurate, out-of-date, or incomplete, or if you have problems accessing or reading the information, please call MERS at 800.767.MERS (6377).