| DEFINED BENEFIT FORMS - EMPLOYER |
|
| Form Title |
Form Number |
| Membership Agreement |
1 |
| Resolution for Adopting MERS Defined Benefit Programs |
2 |
| Employee Prorated Prior Service Agreement |
2A |
| Prior Service Credit - The Prospective MERS Municipality |
3 |
| Resolution Defining a Day of Work or Hours Per Month for MERS Retirement Purposes |
4 |
Resolution to Exclude Temporary Employees from Membership in MERS
|
84 |
Uniform Resolution Defining Hours Per Month for Part-Time Employees
and Service Credit Conversion Upon Promotion to Full-Time Status |
19 |
| Membership Application (Fill form online, print, and sign) |
5 |
| Restated Initial Actuarial Val. and Supp. Val. Proc. Effective 7-1-2006 |
6 |
|
Att. A: Fee Schedule for Initial and Supplemental Actuarial Valuations |
7
|
Att. B: Special Annual Expense Charges Procedure
|
8
|
| Att. C: MERS Statement on Modification of Standard Benefit Programs |
9 |
| Transfer Of Contributions Within MERS Defined
Benefit Plan (excluding Hybrid Benefit Program DB Component) |
10 |
| ■ Request for Initial Actuarial Valuation (Fill form online, print, and sign) |
11 |
| Initial Valuations - Important Comments |
12 |
■ Request for Supplemental Valuation
|
13A |
■ Request for Projection Study
|
13B |
| Supplemental Valuations: Important Comments |
14A |
■ Request for Valuation of Temporary Benefit Program (Window)
(Fill form online, print, and sign) |
15 |
| Window Valuations - Important Comments |
16 |
| Employee Census - Employee Census Spreadsheet (Excel) |
17 |
| Resolution for Changing MERS Benefit (Fill form online, print, and sign) |
18 |
| Resolution Adopting Program PRO (Post Retirement Option) |
82 |
|
I. (B) DEFINED BENEFIT FORMS - EMPLOYEE |
|
Form Title
|
Form Number |
Membership Application (Fill form online, print, and sign)
|
5 |
Beneficiary Change Request (Learn more by watching our 10-Minute Trainer here. )
|
21 |
Member Name and/or Address Change (Fill form online, print, and sign)
|
23 |
Refund Application (Employee)
|
24 |
MERS Safe Harbor Explanation
|
25 |
Refund Application for Deceased Member's Contributions
|
26 |
Verification for the Crediting of Other Governmental Service
|
27 |
Application for Deferred Service Status
|
28 |
Service Retirement
|
|
|
Application for Service Retirement |
29A |
|
Employer's Certification of Termination of Employment for Retiring Member
|
29B |
Return To Work Certification Of Retired Member And Employer Regarding Termination And
Re-Employment Of Retiree (Form under development) |
29C |
Election of Retirement Allowance Option
|
30 |
Pension Recipient's Federal Income Tax Withholding Auth.
(Fill form online, print, and sign)
|
31 |
Application for Retirement Allowance by Surviving Spouse or Child
|
32 |
Statement of Contingent Survivor Beneficiary
|
33 |
Statement of Beneficiary
|
34 |
| Transfer/Rehire Member Certification for Same Employer |
35 |
| Transfer/Rehire Member Rules |
35A |
Electronic Funds Transfer Application (Fill form online, print, and sign)
|
36 |
Stop Payment Request
|
37 |
Certification of Qualified Fund Rollover to MERS (General) with Instructions
|
38 |
Resolution for adopting Benefit Program “E” |
39 |
Option IV Beneficiary Change Request
|
41 |
DROP+ and Election
|
42 |
Affidavit Affirming Existence of Insurable Interest
|
46 |
|
I. (C) DEFINED BENEFIT - DISABILITY |
|
Form Title
|
Form Number |
Application for Disability Retirement
|
51 |
Limitation on Disability Benefits Prior to Age 60
|
52 |
Physician's Statement
|
53 |
Psychiatric Medical Report
|
54 |
Section 24 of MERS Plan Document
|
Section 24
|
Section 29 of MERS Plan Document
|
Section 29 |
Section 36A of MERS Plan Document
|
Section 36A |
|
II. DEFINED CONTRIBUTION FORMS |
|
Form Title
|
Form /Section Number |
| |
| Transfer/Rehire Member Certification for Same Employer |
35
|
Revised Uniform Defined Contribution Program Resolution
|
69 |
Uniform Defined Contribution Program Adoption Agreement
|
70 |
| Employer's Change Request (to Uniform Defined Contribution Adoption Agreement) |
73 |
Section 19A of MERS Plan Document
|
Sec 19A
|
|
III. STABLE INCOME ANNUITY |
|
|
Form Title |
Form Number |
| |
|
New Business
|
|
Immediate Annuity Application
(Complete and submit.) |
8513 |
Acknowledgement of Suitability in an Annuity Purchase
(Complete and submit with application.) |
12216 |
Substitute IRS Forms W-4P and W-9
(Complete and submit with application.) |
5031 |
Stable Income Annuity Disclosure
(Applicant retains.) |
13469 |
Request for EFT of Annuity Payout
(Complete and submit with application as necessary.) |
11426 |
|
Request For Rollover, Transfer or Exchange
(Complete and submit with application as necessary.) |
12213 |
| |
|
Change Requests
|
|
Request for Change of Beneficiary
(Complete and submit.) |
6304 |
Request for Contract Application Amendment
(Complete and submit.) |
6614 |
Request for Change of EFT Annuity Payout
(Complete and submit.) |
11436 |
Qualified Joint and Survivor Annuity Notice and Spousal Consent
(Complete and submit.) |
13018 |
Statement of Beneficiary Claim to Benefits
(Complete and submit.) |
6146 |
Request for Change to Annuity Policy
(Complete and submit.) |
12428 |
Request for Absolute Assignment and Successor Owner Endorsement
(Complete and submit.) |
2527 |
|
IV. HYBRID PROGRAM FORMS |
|
| Form Title |
Form /Section Number |
| Transfer/Rehire Member Certification for Same Employer |
35
|
MERS Uniform Hybrid Program (Benefit Prog H) Resolution
|
43 |
MERS Uniform Hybrid DC Component Adoption Agreement
|
44 |
Section 19B of MERS Plan Document
|
Sec 19B
|
| |
|
|
V. DOMESTIC RELATIONS ORDER (DRO)
ELIGIBLE DOMESTIC RELATIONS ORDER (EDRO) |
|
| Form Title |
Form Number |
MERS DRO (Model)
|
71 |
MERS EDRO
|
72 |
|
VI. MERS PARTICIPATING MUNICIPALITIES AND ACT 88 UNITS |
|
| Form Title |
Form Number |
MERS Participating Municipalities
|
76 |
Reciprocal Retirement Act (“Act 88”) - Adopting Units
|
77 |
Reciprocal Retirement Act (Act 88 of 1961) or Contact MERS for Copy
|
None |
Resolution for Adopting Act No. 88
|
79 |
|
VII. MISCELLANEOUS |
|
| Form/Policy Title |
Form Number |
Customer Contact Form
|
85 |
MERS Enforcement Procedure for Prompt Reporting and Payment
|
86 |
| eBill Provisions |
|
|
|
87 |
|
|
88 |
|
|
89 |
|
|
86 |
Restated Policy for Closed Groups
|
90 |
Amortization Policy for Closed Divisions Within Open Municipalities
|
91 |
