Active Member Forms
Your retirement benefit is an important and, often, substantial part of your compensation package. Some decisions you make are permanent; other decisions may be carried out after your death.
It is crucial that you take great care in managing your retirement benefit. Do not complete a form that you do not understand. If you have any questions, please call 1.800.633.5461 and a SERS professional will assist you. When you do complete a form, please ensure that it is 100% complete, accurate, and accompanied by appropriate supporting documentation, if necessary.
Some forms, such as applications for annuities, must be completed with the assistance of a SERS retirement counselor. Other forms, such as domestic relations orders or powers of attorney, require a third-party to complete, such as a court or a notary. Many members have told us that it is extremely helpful to see these types of forms and to be able to gather required information prior to being asked to complete them. Thus, this page provides sample copies of many forms for your information.
Most Common Forms
Beneficiary Nomination for Active Members
Retirement Estimate Request
Service Purchase Request
Power of Attorney (sample)
Authorization to Release Account Information
Right-to-Know Law Disclosure of Home Address Exception Documentation
Domestic Relations Order (sample)
Leave State Employment without Retiring
Retire from State Employment
If you are looking for a form not provided above, check the forms page for retired members.
SERS provides forms in PDF format. If your computer is not equipped to access PDF files, you can download a free copy of Adobe Reader or you can call 1.800.633.5461 and we'll gladly send whatever you need.
|You can return completed forms to:
Pennsylvania State Employees' Retirement System