Membership Forms

If you would like guidance on how to complete your retirement forms, please click here.

• Change of Information: Use the Change of Information form to tell ERSRI about a name change, new address, new e-mail address or telephone number.
• Beneficiary Designation: Use this form to tell ERSRI who you would like to name as your primary and contingent beneficiaries.
• TIAA Beneficiary Designation:  If you worked after June 30, 2012 within ERSRI, please remember to update your beneficiaries with TIAA as well.  To change your beneficiary online, please visit www.tiaa.org/beneficiary.
• HARTFORD Life Insurance Beneficiary Designation:  Use this HARTFORD Life Insurance Beneficiary Designation form if you would like to name a new beneficiary on your HARTFORD policy.  This form must be sent directly to the HARTFORD Insurance address located on the form.
• Agreement of Trustee/Custodian: Use this form if you have left your job and would like to roll your contributions into another qualified retirement plan.
• Affidavit of Domestic Partnership: Use this form to tell ERSRI about your Domestic Partnership or the termination of a Domestic Partnership.
• Salary Verification for Service Credit: Use this form to help ERSRI determine your service credits based on salary.
• Day Count Verification: Use this form if you are a teacher who needs ERSRI to determine your service credits based on the number of days you have worked.
• Application for Eligibility and Benefit Estimate: Use this form if you are considering retirement and would like to receive information on your retirement eligibility and estimated pension benefit amount.
• Application for Termination Packet: Use this Application for Termination Packet if you are a member of ERSRI/MERS and are requesting a refund of contributions.
• Employer Certification Termination: Use this Employer Certification Termination form upon termination of employee.