To assure the use of the most current form, SERS recommends not to download blank forms to your computer. These forms can now be completed online if you have Adobe Reader 5.1 or newer. Once the form is filled out, please print it (sign the form if necessary) and mail to SERS. A copy of the form should be kept for your records. The completed unsigned form can be saved to your computer for your records.

Contact your Retirement Coordinator (RC) if you need assistance with any form. Your RC's name and phone number can be found on your Annual Statement.

Miscellaneous Forms

Form 101 Nomination of Beneficiary

This form is to be used to nominate the person or persons to receive any death benefit payable by the State Employees' Retirement System of Illinois. This is a legal document which, after preparation, may not be altered in any way by any person. A member desiring to change beneficiaries at a later date must complete a new Beneficiary form. The form on file with SERS that has the most recent date, located next to the member's signature, will take precedence.

Form 501 Change of Information

This form may be used by benefit recipients only to make member information change. If you are an active employee, you must contact your payroll office to make these changes.

Form 2003 Service Credit Request

This form is used by members to request estimates on the purchase of optional service.

Form 3034 Request for Payment to Trust

The appropriate legal documents establishing the trust must accompany this form. A trust is a property arrangement on which a trustee, such as a person or a bank trust department, holds title to, takes care of , and in most cases, manages property for the benefit of one or more third parties (beneficiaries). You should seek legal advice if you are setting up a trust.

Form 3606 Small Estates Affidavit

This document is used when the total of an Illinois decedent's estate is less than $100,000.00 AND the estate does not own real estate. A small estates affidavit may be used to transfer property to the decedent's beneficiaries/heirs without opening a formal probate estate. You should seek legal advice to complete this form.

Form W-4P Federal Withholding Certificate

This form is used to change Federal tax withholding from your SERS payment.

Form 3965 Illinois State Income Tax Withholding

This form is used to withhold state income tax from your SERS payment. While you are not required to pay state income tax on your SERS benefit, you may wish to have a tax deduction under some circumstances. If so, complete this form and send to SERS Vouchering Section.

Pension Benefit Forms

Retirement Packet and other Retirement Information

This packet is used for starting your retirement process in a step by step instruction. There are other helpful tools within this area to help with your retirement questions.

Form 3844 Reversionary Annuity

This form is to be completed if you are electing a reversionary annuity. A reversionary annuity is paid when you voluntarily reduce your monthly retirement annuity to provide a portion of that annuity to your surviving spouse upon your death. Please read the Reversionary Annuity booklet provided to you in the publications section of the SERS web site. If you are interested, call SERS Pension Section and they will provide you with information needed to complete this form.

Survivor Benefit Forms

Form 3033 Student Recertification/Decertification for Survivor's Annuity

This form is automatically sent to the appropriate survivor's benefit recipients. If you misplaced the original sent to you this form can be downloaded and used. Please have the school you attend complete the lower portion of the form.