Member Forms

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Member Forms

Most of the forms below are available in Portable Document Format (PDF). You may need to download a free copy of the Adobe Acrobat® Reader™ to open them. If you prefer to receive a form or publication by mail, click here.

Form Name	Form Number
Personal Information Change Form Members may also change address using the online Member Change of Address Form	5.201a
Member Beneficiary Designation	6.33
Service Retirement Application *Service Retirement Application Instructions	5.32
Direct Deposit Form	5.124
Authorization for Release of Member Information	5.221
Division of Property Order Form
Application for Refund *Special Tax Notice regarding the Taxable Portion of your Refund	REF-0013
Application for Payment from a Reemployed Retiree’s Account	5.61
Request a Statement of Account (online form)
Request a Service Retirement Estimate (online form)
Notice of Death (online form)

Service Credit Purchase Forms

Form Name	Form Number
Rollover Distribution to SERS	30.34
Certification of Salary for Non-Contributing Service	35.2
Certification of School Service	35.35
Certification of Service	35.42
Resignation Due to Adoption or Pregnancy	35.52

300 E. Broad St., Suite 100
Columbus, OH 43215-3746
Directions to SERS

Columbus area:
(614) 222-5853

Members toll-free:
(866) 280-7377

Retirees toll-free:
(800) 878-5853