Forms - Member Forms

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.

02-01A 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.

02-12 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.

02-19 Application to Transfer/Upgrade Service into the Hazardous Duty Services Plan

This forms is used by members who seek to transfer/upgrade service credit into the Hazardous Duty Services Plan.

03-02 Alternate Payee 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.

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.

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 of Creditable Service

This form is used by active members who seek to transfer service credit in another system to 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.

02-16 Request Research of Refundable Contributions

This form allows a member to request a search to verify if they have any contributions available for refund.

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 July 31, 2002, and elects to rejoin the LASERS Defined Benefit Plan. The member must complete this form.

Retiree Members

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.

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 W-4P

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.