Thursday, December 8, 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 # Product Name Audience myMers Info
F-29c DB, Hybrid Working in Retirement Certification Participant False more information

Working in Retirement Certification

Form #: F-29c

Product: DB, Hybrid
Audience: Participant

F-31b DB, DC, Hybrid Withholding for Pension or Annuity Payments Participant False more information

Withholding for Pension or Annuity Payments

Form #: F-31b

Product: DB, DC, Hybrid
Audience: Participant

F-27 DB, DC, Hybrid Verify Other Governmental Service Participant False more information

Verify Other Governmental Service

Form #: F-27

Product: DB, DC, Hybrid
Audience: Participant

MD-412 457 Unforeseeable Emergency Withdrawals Participant False more information

Unforeseeable Emergency Withdrawals

Form #: MD-412

Product: 457
Audience: Participant

F-10 DB Transfer Of Contributions (excluding Hybrid) Participant False more information

Transfer Of Contributions (excluding Hybrid)

Form #: F-10

Product: DB
Audience: Participant

F-32 DB, Hybrid Survivor Beneficiary Application Participant False more information

Survivor Beneficiary Application

Form #: F-32

Product: DB, Hybrid
Audience: Participant

F-37 DB Stop Payment Participant False more information

Stop Payment

Form #: F-37

Product: DB
Audience: Participant

6146 Annuity Statement of Beneficiary Claim to Benefits Participant False more information

Statement of Beneficiary Claim to Benefits

Form #: 6146

Product: Annuity
Audience: Participant

F-35B DB Standard Transfer Member Certification for Same Employer Participant False more information

Standard Transfer Member Certification for Same Employer

Form #: F-35B

Product: DB
Audience: Participant

MD-406 457 Spousal Beneficiary Claim Participant False more information

Spousal Beneficiary Claim

Form #: MD-406

Product: 457
Audience: Participant

MD-006 DC Spousal Beneficiary Claim Participant False more information

Spousal Beneficiary Claim

Form #: MD-006

Product: DC
Audience: Participant

MD-009 DC Required Minimum Distribution Participant False more information

Required Minimum Distribution

Form #: MD-009

Product: DC
Audience: Participant

MD-409 457 Required Minimum Distribution Participant False more information

Required Minimum Distribution

Form #: MD-409

Product: 457
Audience: Participant

6614 Annuity Request for Contract Application Amendment Participant False more information

Request for Contract Application Amendment

Form #: 6614

Product: Annuity
Audience: Participant

12428 Annuity Request for Change to Annuity Policy Participant False more information

Request for Change to Annuity Policy

Form #: 12428

Product: Annuity
Audience: Participant

11436 Annuity Request for Change of EFT Annuity Payout Participant False more information

Request for Change of EFT Annuity Payout

Form #: 11436

Product: Annuity
Audience: Participant

2527 Annuity Request for Absolute Assignment / Successor Owner Endorsement Participant False more information

Request for Absolute Assignment / Successor Owner Endorsement

Form #: 2527

Product: Annuity
Audience: Participant

F-26 DB Refund Application for Deceased Member's Contributions Participant False more information

Refund Application for Deceased Member's Contributions

Form #: F-26

Product: DB
Audience: Participant

F-24 DB Refund Application Participant False more information

Refund Application

Form #: F-24

Product: DB
Audience: Participant

13018 Annuity Qualified Joint and Survivor Annuity Notice / Spousal Consent Participant False more information

Qualified Joint and Survivor Annuity Notice / Spousal Consent

Form #: 13018

Product: Annuity
Audience: Participant

F-38 DB Qualified Fund Rollover to MERS Participant False more information

Qualified Fund Rollover to MERS

Form #: F-38

Product: DB
Audience: Participant

F-54 DB Psychiatric Medical Report Employer, Participant False more information

Psychiatric Medical Report

Form #: F-54

Product: DB
Audience: Employer, Participant

F-53 DB Physician's Statement of Disability Employer, Participant False more information

Physician's Statement of Disability

Form #: F-53

Product: DB
Audience: Employer, Participant

MD-001 DB, DC, Hybrid, HCSP, 457 Personal Information Participant False more information

Personal Information

Form #: MD-001

Product: DB, DC, Hybrid, HCSP, 457
Audience: Participant

F-31 DB, Hybrid Pension Federal Income Tax Participant, Retiree False more information

Pension Federal Income Tax

Form #: F-31

Product: DB, Hybrid
Audience: Participant, Retiree

F-41 DB Option IV Beneficiary Participant False more information

Option IV Beneficiary

Form #: F-41

Product: DB
Audience: Participant

MD-415 457 Opt Out Refund Participant False more information

Opt Out Refund

Form #: MD-415

Product: 457
Audience: Participant

MD-007 DC Non-Spousal Beneficiary Claim Participant False more information

Non-Spousal Beneficiary Claim

Form #: MD-007

Product: DC
Audience: Participant

MD-407 457 Non-Spousal Beneficiary Claim Participant False more information

Non-Spousal Beneficiary Claim

Form #: MD-407

Product: 457
Audience: Participant

F-72 DB Model EDRO Participant False more information

Model EDRO

Form #: F-72

Product: DB
Audience: Participant

F-71 DB Model DRO Participant False more information

Model DRO

Form #: F-71

Product: DB
Audience: Participant

F-78 HCSP Model DRO Participant False more information

Model DRO

Form #: F-78

Product: HCSP
Audience: Participant

F-73 457 Model DRO Participant False more information

Model DRO

Form #: F-73

Product: 457
Audience: Participant

F-75 DC Model DRO Participant False more information

Model DRO

Form #: F-75

Product: DC
Audience: Participant

MD-016 DC MERS-to-MERS Service Verification Participant False more information

MERS-to-MERS Service Verification

Form #: MD-016

Product: DC
Audience: Participant

F-05 DB Membership Application Employer, Participant False more information

Membership Application

Form #: F-05
Description:

test summary


Product: DB
Audience: Employer, Participant

MD-410 457 Loan Application Participant False more information

Loan Application

Form #: MD-410

Product: 457
Audience: Participant

MD-010 DC Loan Application Participant False more information

Loan Application

Form #: MD-010

Product: DC
Audience: Participant

F-52 DB Limitation on Disability Benefits – Affidavit Participant False more information

Limitation on Disability Benefits – Affidavit

Form #: F-52

Product: DB
Audience: Participant

MD-402 457 Investment Change Participant True more information

Investment Change

Form #: MD-402

Product: 457
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

MD-002 DC Investment Change Participant True more information

Investment Change

Form #: MD-002

Product: DC
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

MD-102 HCSP Investment Change Participant True more information

Investment Change

Form #: MD-102

Product: HCSP
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

MD-302 Hybrid Investment Change Participant True more information

Investment Change

Form #: MD-302

Product: Hybrid
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

MD-008 DC In-Service Withdrawal Request Participant False more information

In-Service Withdrawal Request

Form #: MD-008

Product: DC
Audience: Participant

MD-408 457 In-Service Withdrawal Participant False more information

In-Service Withdrawal

Form #: MD-408

Product: 457
Audience: Participant

MD-404 457 Incoming Transfer Participant False more information

Incoming Transfer

Form #: MD-404

Product: 457
Audience: Participant

MD-004 DC Incoming Rollover Participant False more information

Incoming Rollover

Form #: MD-004

Product: DC
Audience: Participant

MD-304 Hybrid Incoming Direct Rollover Participant False more information

Incoming Direct Rollover

Form #: MD-304

Product: Hybrid
Audience: Participant

F-36 DB, Hybrid Funds Transfer – Direct Deposit Authorization Participant False more information

Funds Transfer – Direct Deposit Authorization

Form #: F-36

Product: DB, Hybrid
Audience: Participant

MD-100 HCSP Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-100

Product: HCSP
Audience: Employer, Participant

MD-300 Hybrid Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-300

Product: Hybrid
Audience: Employer, Participant

MD-000 DC Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-000

Product: DC
Audience: Employer, Participant

MD-400 457 Enrollment Kit Employer, Participant False more information

Enrollment Kit

Form #: MD-400

Product: 457
Audience: Employer, Participant

F-42 DB DROP+ and Election Participant False more information

DROP+ and Election

Form #: F-42

Product: DB
Audience: Participant

MD-405 457 Distribution/Direct Rollover Participant True more information

Distribution/Direct Rollover

Form #: MD-405

Product: 457
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

MD-005 DC Distribution / Direct Rollover Participant True more information

Distribution / Direct Rollover

Form #: MD-005

Product: DC
Audience: Participant

myMERS: Yes, this form can be completed via an online process by logging into your myMERS account. Click to log in.

12999 Annuity Disclosure Participant False more information

Disclosure

Form #: 12999

Product: Annuity
Audience: Participant

MD-414 457 Contribution Catch Up Participant False more information

Contribution Catch Up

Form #: MD-414

Product: 457
Audience: Participant

F-50 DB, Hybrid Consent / Authorization: Application for Disability Retirement Participant False more information

Consent / Authorization: Application for Disability Retirement

Form #: F-50

Product: DB, Hybrid
Audience: Participant

MD-103 HCSP Beneficiary Designation Participant False more information

Beneficiary Designation

Form #: MD-103

Product: HCSP
Audience: Participant

MD-003 DC Beneficiary Designation Participant False more information

Beneficiary Designation

Form #: MD-003

Product: DC
Audience: Participant

MD-403 457 Beneficiary Designation Participant False more information

Beneficiary Designation

Form #: MD-403

Product: 457
Audience: Participant

MD-303 Hybrid Beneficiary Designation Participant False more information

Beneficiary Designation

Form #: MD-303

Product: Hybrid
Audience: Participant

6304 Annuity Beneficiary Participant False more information

Beneficiary

Form #: 6304

Product: Annuity
Audience: Participant

F-21 DB Beneficiary Participant False more information

Beneficiary

Form #: F-21

Product: DB
Audience: Participant

F-29 DB Application for Retirement Participant False more information

Application for Retirement

Form #: F-29

Product: DB
Audience: Participant

F-51 DB Application for Disability Retirement Employer, Participant False more information

Application for Disability Retirement

Form #: F-51

Product: DB
Audience: Employer, Participant

F-35C DB Alternative Transfer Member Certification for Same Employer Participant False more information

Alternative Transfer Member Certification for Same Employer

Form #: F-35C

Product: DB
Audience: Participant

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

Alternate Payee (Former Spouse) Benefit Application

Form #: F-48

Product: DB
Audience: Participant

8513 Annuity Adoption Packet Participant False more information

Adoption Packet

Form #: 8513

Product: Annuity
Audience: Participant

MD-413 457 457 In-Plan Roth Conversion Employee False more information

457 In-Plan Roth Conversion

Form #: MD-413

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).