skip to navigation | skip to content
  • A
  • A
  • A
    A A A

    Forms - Member Forms

    Are you having trouble viewing a form? Please update to the latest version of Adobe Reader or right-click the form link and save the document to your machine.

    General Forms

    01-02 Change of Address
    This form is used by retirees and members that have been out of state service for 6 months or more to update their mailing address with LASERS. This update can be made through Retiree Self Service also.
    01-06 Designation of Beneficiary
    Member may use this form to designate a beneficiary.
    01-07 Change of Name
    Member may use this form to change their name on their account with LASERS.
    02-01 Refund of Accumulated Contributions
    Members who leave state service and do not retire may request a refund of employee contributions paid into LASERS while employed.
    02-01A Authorization for Direct Rollover
    This form is used when a member wishes to roll over any lump sum to a traditional IRA or another qualified employer plan. It is a supplemental page to forms 2-1: Refund of Accumulated Contributions, 6-1: Application for Retirement, 6-1 A&B: Application for Retirement with IBO; 9-2: Certification at End of Employment, and 9-3: Request for Withdrawal from DROP/IBO Account.
    02-02 Emergency Refund Request
    Refunds of accumulated contributions may be made in less than 30 calendar days using this form along with the Refund of Accumulated Contributions form, and appropriate proof of emergency.
    02-12 Application for Repayment of Refunded Service to Reciprocate/Transfer
    This form should be used to determine the cost to restore service credit to LASERS in order to transfer the service out of LASERS to another Louisiana retirement system, or to reciprocate the service with another Louisiana retirement system.
    02-16 Request Research of Refundable Contributions
    This form allows a member to request a search to verify if they have any contributions available for refund.
    03-02 Spouse and Adult Child Selection of Distribution
    This form is used when a member provides, in advance, for an alternate distribution of benefit for the surviving spouse without minor children under certain circumstances.
    05-01 Request for Retirement Benefit Estimate
    This form is for LASERS members who are within 18 months of retirement or DROP eligibility to request an estimate. Estimates are limited to one request per year from the date of your current request. You may create your own retirement benefits estimate using the Member Self-Service portal.
    Legal Married Members with Separate Property Agreements
    Married members who chose to remain separate in property (rather than enter into a community property regime) do not need spousal consent to select their retirement option or retirement beneficiary. This form must be completed as a part of the retirement process.
    MSD32 Request for Contribution Income Verification
    Members should use this form when requesting a contribution balance or verification of income.
    MSD46 Disability Appeal
    This form is completed when a disability applicant has been denied by the LASERS Board and wishes to appeal the Board's denial.
    PREP Preretirement Education Program (PREP) Seminar Application
    If you wish to complete a paper application instead of registering via the website, please complete this application and mail it in.

    Active Members

    02-03 Application for Reciprocal Recognition of Service
    Reciprocal Agreement is the recognition of the member's service credit in one Louisiana retirement system by another Louisiana retirement system and involves no cost to the member. Each system considers this service credit in the other system when determining his eligibility for regular retirement, DROP, disability retirement, and survivor benefits. Six months of service in this current system is required to apply for a reciprocal agreement or a transfer of service.
    02-04 Application for Transfer and/or Upgrade of Creditable Service
    This form is used by active members who seek to transfer service in another system to LASERS. It should also be used to obtain a calculation to upgrade the service credit transferred on or after June 30, 2013, if a higher accrual rate is currently earned at LASERS.
    02-06 Application for Purchase of Military Service
    This form should be used, under the provisions of La. R.S. 11:153, by active members of LASERS to purchase up to four years of service credit for military service, provided members were honorably discharged.
    02-07 Application for Purchase of Service R.S. 11 429 (B)
    This form should be used, under the provisions of La. R.S. 11:429(B), by any active member of the system who has credit in the system for at least five years of service. The member shall be eligible to obtain credit for up to five years of service credit in one-year increments.
    02-11 Application for Repayment of Refunded Service
    This form should be used by active members to repay a refund to the system upon returning to state service and contributing to the system for eighteen months, whether full time or part time, provided such repayment is made prior to retirement.
    02-13 LASERS Acceptance Letter of Rollover Assets
    This form can be used by active/eligible members to purchase, repay, or transfer service credit into LASERS.
    02-14 Legislative Upgrade Invoice Request
    This form is used by active members to upgrade certain service to the Legislative rate. There is an actuarial fee and cost may be associated with this upgrade.
    02-15 Judicial Upgrade Invoice Request
    This form is used by active members to upgrade certain service to the Judicial rate. There is an actuarial fee and cost may be associated with this upgrade.
    02-20 Application for Purchase of Federal Service
    This form may be used by active members who wish to purchase their prior federal service for credit with LASERS.
    15-01A ORP Defined Contribution Plan Transfer to LASERS Defined Benefit Plan
    This form should be used, as specified in La. R.S. 11:502, by an active member, who enrolled in the Optional Retirement Plan (ORP) from July 1, 2000, through December 31, 2007, and elects to rejoin the LASERS Defined Benefit Plan. The member must complete this form to apply for an invoice.

    Retiree Members

    03-03 Survivor Marital Status Update
    Survivors use this form to notify LASERS of changes in their marital status.
    04-03 Disability Retiree Earned Income Statement
    For LASERS to conform with state law (La R.S.11:221), each disability retiree must complete this form detailing earned income in the previous tax year (even if there was no earned income).
    04-04 Spousal Consent Form
    A married member must choose a retirement option which provides a benefit for the spouse that is at least fifty percent (50%) of the benefit payable to the retiree. The member may choose a payout with no survivor annuity or name another individual as beneficiary, if the spouse agrees with the choice and signs in the presence of a Notary Public. (La R.S. 11:446 (F)).
    04-05 Authorization for Direct Deposit
    This form authorizes direct deposits into your account and is to be used only for your LASERS benefit.
    04-06 Application for Waiver of Electronic Funds Transfer Requirement
    This application should be used by any person seeking an exception to receiving payment via EFT and certifies in writing to the board of trustees that he or she does not have an account with a financial institution, or that payment by electronic funds transfer would impose a hardship due to a physical disability or geographic barrier, or would impose a financial hardship.
    06-03 Option 2B Mentally Handicapped Designee
    This form is used to verify information regarding a Mentally Handicapped Designee.
    09-03 Request for Withdrawal from DROP-IBO
    This form is used when a member elects to make withdrawals from their Deferred Retirement Option Plan (DROP)/ Initial Benefit Option (IBO) account.
    09-04 Transfer to Self-Directed Plan
    This form is used by retiree members who became eligible prior to Jan. 1, 2004, and have an option to enter the Self-Directed Plan (SDP) or remain with LASERS. The member will be able to transfer 100% of their balance to the SDP upon completion of the DROP accumulation period.
    10-01 Beneficiary Signature
    In order for payment to be made to a beneficiary, LASERS must have a certified copy of the participant's death certificate and a 10-1 Beneficiary Signature Form.
    10-06 Application for Change in Retirement Benefit Due to Divorce
    This form may be completed by LASERS Retirees who divorce and obtain a certified court order for their spouse to relinquish rights to their retirement benefits.
    10-07 Application for Change in Retirement Benefit Due to Death of Beneficiary
    This form may be completed by a LASERS Retiree that chose an option other than the Maximum option, but whose named beneficiary has predeceased the retiree. The retiree may apply to increase the monthly retirement benefit to the amount that would have been received had the Maximum option been selected.
    MSD12 Annual Attending Physician's Statement
    This form is completed by disability retirees every year for the first five years of their retirement and every three years thereafter to certify their continuing disability status.
    MSD14 Certification of Student Status
    This form should be completed by student survivors in January and August of each year.
    MSD40 Verification of Student Status
    This form should be completed by student survivors in April and November of each year.
    MSD64 Student School Certification and Release
    This form is to be completed by student survivors at the start of all semesters or whenever they change schools.
    W-4P Withholding Certificate for Pension or Annuity Payments
    Form W-4P is for U.S. citizens, resident aliens, or their estates who are recipients of pensions, annuities (including commercial annuities), and certain other deferred compensation. Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s) and which LASERS account(s) you would like the tax to apply. (i.e. Service, DROP, Beneficiary or ALL). You also may use Form W-4P to choose (a) not to have any federal income tax withheld from the payment (except for eligible rollover distributions, or payments to U.S. citizens delivered outside the United States or its possessions) or (b) to have an additional amount of tax withheld.
    Legal Limited Power of Attorney Form
    This form allows a retired member to appoint someone as their agent for the purpose of managing the deposit of LASERS benefits.