Friday, December 14, 2018

MERS Forms

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= Available on myMERS. Forms with a star may be completed Online by logging into your myMERS account. Click here to log in.
 
Abbreviations
DB = Defined Benefit, DC = Defined Contribution, DC+ = Defined Contribution Plus, HCSP = Health Care Savings Program, RHFV = Retiree Health Funding Vehicle, ISP = Investment Services Program, Premier Adv = Premier Advantage, Annuity = Stable Income Annuity, GL&D = Group Life & Disability Insurance.

Defined Benefit

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-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

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

DB-004 DB Service Credit Purchase Opt-Out Form Employer False more information

Service Credit Purchase Opt-Out Form

Form #: DB-004

Product: DB
Audience: Employer

DB-001b DB Resolution Adopting The MERS Defined Benefit Plan Employer False more information

Resolution Adopting The MERS Defined Benefit Plan

Form #: DB-001b

Product: DB
Audience: Employer

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

F-79 DB, DC, Hybrid Reciprocal Units (Act 88) - Resolution Employer False more information

Reciprocal Units (Act 88) - Resolution

Form #: F-79

Product: DB, DC, Hybrid
Audience: Employer

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

DB-013b DB, DC, Hybrid Projection Study Employer False more information

Projection Study

Form #: DB-013b

Product: DB, DC, Hybrid
Audience: Employer

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

DB-002c DB Part-Time to Full-Time Service Credit Conversion Employer False more information

Part-Time to Full-Time Service Credit Conversion

Form #: DB-002c

Product: DB
Audience: Employer

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

Other Governmental Service Application

Form #: F-27

Product: DB, DC, Hybrid
Audience: Participant

F-41 DB Option IV Beneficiary Participant False more information

Option IV Beneficiary

Form #: F-41

Product: DB
Audience: Participant

n/a DB Model EDRO Qualification Participant False more information

Model EDRO Qualification

Form #: n/a
Description:

EDRO Qualification, ELIGIBLE DOMESTIC RELATIONS ORDERS
REVIEW AND QUALIFICATION
(DEFINED BENEFIT PLAN)


Product: DB
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-05 DB Membership Application Employer, Participant False more information

Membership Application

Form #: F-05
Description:

test summary


Product: DB
Audience: Employer, 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

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

Funds Transfer – Direct Deposit Authorization

Form #: F-36

Product: DB, Hybrid
Audience: Participant, Retiree

DB-094 DB Employer Resolution Establishing Uniform Transfer Provision Employer False more information

Employer Resolution Establishing Uniform Transfer Provision

Form #: DB-094
Description:

Employer form: Defined Benefit Uniform Transfer form. DB-094


Product: DB
Audience: Employer

F-17 DB Employee Census Employer False more information

Employee Census

Form #: F-17

Product: DB
Audience: Employer

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

DROP+ and Election

Form #: F-42

Product: DB
Audience: Participant

DB-007 DB Defined Benefit Plan Surplus Division Adoption Addendum Employer False more information

Defined Benefit Plan Surplus Division Adoption Addendum

Form #: DB-007

Product: DB
Audience: Employer

F-56 DB Defined Benefit DROP Distribution Request Form Participant False more information

Defined Benefit DROP Distribution Request Form

Form #: F-56

Product: DB
Audience: Participant

F-85 DB, DC, HCSP, 457, Hybrid, RHFV Customer Contact Employer False more information

Customer Contact

Form #: F-85

Product: DB, DC, HCSP, 457, Hybrid, RHFV
Audience: Employer

DB-013a DB Benefit Change - Permanent or Temporary Employer False more information

Benefit Change - Permanent or Temporary

Form #: DB-013a

Product: DB
Audience: Employer

F-21 DB Beneficiary Change Participant False more information

Beneficiary Change

Form #: F-21
Description:

Defined Benefit participant form for changing or designation of beneficiaries. 


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-55 DB Application for Defined Benefit Deferred Retirement Option Program (DROP) Participant False more information

Application for Defined Benefit Deferred Retirement Option Program (DROP)

Form #: F-55

Product: DB
Audience: 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

DB-002 DB Adoption Agreement Employer False more information

Adoption Agreement

Form #: DB-002

Product: DB
Audience: Employer

DB-001a DB Admin Order Adopting The MERS Defined Benefit Plan Employer False more information

Admin Order Adopting The MERS Defined Benefit Plan

Form #: DB-001a

Product: DB
Audience: Employer

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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).