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Forms Download
 
 Instructions
 

Welcome to the ERSRI Forms Download page.

We recommend that you obtain all of your forms by downloading and printing them from this website. This ensures that you are using the most up-to-date version of the form that ERSRI has available. For your convenience, these forms have been categorized into Membership Forms, Retiree Forms and General Forms.You need to have the latest version of the Adobe® Acrobat® Reader® to download forms. You can download the latest version of Adobe® Acrobat® Reader® using the link below.
 

Once you have successfully installed the Adobe® Acrobat® Reader®, click on the links below to download the forms.

 Membership Forms  
 General Membership Forms
  Beneficiary Nomination: Form that nominates a member's primary and contingent beneficiaries
  MERS Member Election: Optional form for Member election into ERSRI (only applicable for MERS plan)
  Post-Retirement Employment: Form to report post retirement employment to ERSRI
Optional Service Credit Forms
  Call Fire Fighter Credit Request: Form for purchasing call fire fighter credit
  Military Credit Request: Form for purchasing military credit
  Non-Participating Municipality Credit Request: Form for non-participating municipality credit
  Nurse Teaching Credit Request: Form for purchasing nurse teaching credit
  Official Layoff Verification: Form for purchasing official layoff
  Official Leave Verification: Form for purchasing official leave
  Out of State Teaching Credit Request: Form for purchasing out of state teaching credit
  Part-time Teacher Verification: Form for purchasing part-time teacher credit
  Payroll Deduction Authorization: Form for payroll deductions
  Peace Corps Credit Request: Form for purchasing peace corps credit
  Prior Time Verification: Form for purchasing prior time
  Private Teaching Credit Request: Form for purchasing private teaching credit
  Probationary Time Verification: Form for purchasing probationary time
  Refund Payback Request: Form for purchasing refund payback
  Substitute Teacher Verification: Form for purchasing substitute teacher credit
  Teacher Corps Credit Request: Form for purchasing teacher corps credit
  VISTA Credit Request: Form for purchasing VISTA credit
  Vocational Education Credit: Form for purchasing vocational education credit
  Refund Forms
  Refunds Packet: Form to refund accumulated distributions to a member
  Agreement of Trustee/Custodian: Form that is an agreement between a member and financial institution. This form allows a member to rollover a refund into a qualified retirement account (i.e. IRA)
 
 Retiree Forms
  General Retirement Forms
  Tax Change: Form used to change the amount of tax withheld from a member's monthly paycheck
  Direct Deposit: Form that authorizes ERSRI to deposit your pension check directly into your bank account
  AETNA Designation of Beneficiary Form: Form that is used to nominate beneficiaries for AETNA Life Insurance Company
  Health Forms
  Health Care Cancellation Form: Form that gives the retirees the option to cancel health care benefits.
 
 General Forms
  Member/Retiree Forms
  Change of Information: Form that changes the name, address, and/or telephone number of a member
  Forgery Affidavit: Form completed by member when he/she thinks refund or benefit payment was forged
  Salary Verification for Purchases: Form for reporting salary for determining Service Credit
  Day Count Form for Teachers: Form for verification of contributing Service Credit
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