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.

Form Name	Form Number
Personal Information Change Form	VER-0002
Member Beneficiary Designation	VER-0006
Service Retirement Application *Service Retirement Application Instructions	ACK-0008
Direct Deposit Form	MBS-0012
Authorization for Release of Member Information	MBS-0002
Division of Property Order Form
Application for Refund - Special Tax Notice included	REF-0013
Application for Payment from a Reemployed Retiree’s Account	BEN-0050
Notice of Death (online form)

Service Credit Purchase Forms

Form Name	Form Number
Rollover Distribution to SERS	SCP-0006
Certification of Salary for Non-Contributing Service	SCP-0017
Certification of School Service	SCP-0031
Certification of Service	SCP-0011
Resignation Due to Adoption or Pregnancy	SCP-0014

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