Below is a list of some commonly used retirement forms. Please fill out the PDF fillable form, print the form, sign & witness the form (as required) and return it to our office.
Forms for Members:
- New Member Enrollment Form - This form is to be used to apply for membership in the Falmouth Retirement System
- Beneficiary Selection Form - This form is to be used to name an eligible beneficiary(s) to receive a lump-sum payment of accumulated total deductions should the member die before retirement
- Beneficiary Selection Form (Option D) - This form is to be used to name an eligible beneficiary to receive a monthly allowance should the member die before retirement
- Statement Concerning Your Employment in a Job Not Covered by Social Security - This form is to be used to acknowledge employment in a job not covered by Social Security
- Veterans' Buyback Form - This form is to be used to request to purchase creditable service for military service
- Refund Application - This form is to be used to request a withdrawal or transfer of accumulated total deductions
- Pre-Tax Rollover Form - This form is to be used to make an eligible rollover distribution for the purchase of creditable service
- Lump Sum Distributions: Special Tax Notice - This notice is to provide information when deciding how to receive a lump sum distribution
- Voluntary Retirement Form - This form is to be used to apply for a “regular” retirement benefit
- Retirement Option Selection Form - This form is to be used to select a retirement allowance per option A, option B or option C
Forms for Retirees & Survivors:
- Beneficiary Change Form - This form is to be used by a retired member to change his/her option B beneficiary
- Application for s. 105 Reinstatement - This form is to be used by a retired member to apply for reinstatement to active service
- Spousal Affidavit to Determine Benefit Eligibility - This form is to be used by spouse seeking to determine eligibility to receive survivor benefits
- Application for Member Survivor Benefits - This form is to be used by survivor to apply for survivor benefits
- Notice of Election of Benefits under 12(2)(d) - This form is to be used by survivor to select method of payment of survivor benefits
Forms for Disability Retirement:
- Disability Retirement Form - This form is to be used by a member to apply for a voluntary disability retirement benefit
- Involuntary Disability Retirement Application - This form is to be used by an employer to apply for an involuntary disability retirement benefit
- Employer Statement for Disability Retirement Application - This form is to be used by an employer to provide information with regards to their employee’s application for disability retirement benefit
- Authorization to Use or Disclose Protected Health Information - This form is to be used to provide authorization to use or disclose protected health information
- Disability Retiree Earned Income Worksheet - This form is to be used to determine how much a retiree can earn during a calendar year
- Disability Application Glossary of Terms - This notice is to provide a glossary of terms relevant to disability retirement