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Maine Public Employees Retirement System
P.O. Box 349, Augusta, ME 04332-0349
toll free: (800) 451-9800 ● local: (207) 512-3100

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(Employer) Forms
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Forms may be downloaded by clicking the corresponding form number below. The "Request Forms" e-mail is for ordering hardcopy forms only. For all other inquiries, please contact MainePERS directly. Note: The forms below are specific to Employers use. For all other MainePERS forms, visit the Forms section. To use these forms you will need Adobe Reader. If you don't have Reader, you can get it free by visiting www.adobe.com. 

+ Forms indicated with "+" may be viewed and completed on the screen using a recent version of Adobe Reader, printed, and mailed to the MainePERS. You may click on any line to complete that area or use TAB to move forward and SHIFT-TAB to move back. Forms cannot be saved or altered.
 
AC-1182 Authorization Agreement for Preauthorized ACH Credits - DB Plan Request Form
AC-1181+ Authorization Agreement for Preauthorized ACH Debits - DB Plan Request Form
GI-0881+ Cancellation/Reduction in Coverage Request Form
GU-1021 Confidentiality Election Form - Home Contact Information Request Form
GI-0880+ Dependent Insurance Request Form
GI-0912+ Designation of Beneficiary - Group Life Insurance
(Individuals completing this form might also consider completing the
Designation of Beneficiary Pre-Retirement Death Benefits
form.)
Request Form
CL-0722+ Designation of Beneficiary Pre-Retirement Death Benefits
(Individuals completing this form might also consider completing the Change of Beneficiary Group Life Insurance form.)
Request Form
CL-0722A Information Regarding Designation of Beneficiary Pre-Retirement Death Benefits Request Form
EM-0003+ MainePERS Employer Security Administrator Authorization Request Form
MM-0002+ Member/Benefit Recipient Data Update Request Form

GU-1016

Payment or Award at Retirement Certification Form Request Form
GI-0874+ Request for Basic and/or Additional Insurance Coverage Requiring Evidence of Insurability Request Form
Package Service Retirement Application Package Request Package



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Information contained on this Web site is neither a legal reference nor a complete statement of the laws or MainePERS administrative rules. In any conflict between this information and Maine laws or administrative rules, the laws and administrative rules shall prevail.

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