Downloadable Forms

General Membership Forms

• Employer's Certification of Creditable Service and Regular Compensation in Connection with Shift Substitution (October, 2011)
• Application for Withdrawal of Accumulated Total Deductions (June, 2011)
• Beneficiary Selection Form (if member dies before retirement)
• New Member Enrollment Form
• Beneficiary Change Form (Option B) (if member dies after retirement)
• Application for Voluntary Superannuation Retirement (November, 2011)
• Choice of Retirement Option Form at Retirement
• Employer's Request for Information

Disability Forms

• Member's Application for Disability Retirement with Introduction
• Glossary of Terms for Disability Application (12/2009)
• Employer's Statement with Introduction
• Treating Physician's Statement with Introduction (3/2009)
• Checklist for Accidental Disability Retirement (12/2009)
• Involuntary Retirement Application with Introduction

Miscellaneous Forms

• Referral Report of Potential Fraud (Please Read Below*)
• Change of Address

*If you have reason to believe that public pension fraud may have occurred or is about to occur, please promptly notify PERAC's Fraud Prevention Unit. The Unit will review each such report and undertake such further investigation as it deems necessary and proper to determine the validity of the transaction. You may reach the Fraud Prevention Unit at 1-800-445-3266. You may also file a written Referral Report of Potential Fraud with the Unit (PERAC, 5 Middlesex Ave., Suite 304, Somerville, MA 02145) or you may email the Unit.