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Forms

Active Member Forms

Application for Withdrawal of Contributions or Deferred Retirement
Use this form at time of separation to request a withdrawal of contributions and interest, defer retirement to age 60, or to transfer your contributions to an Individual Retirement Account or other qualified pension plan.

Beneficiary Designation Form
Use this form to designate beneficiaries in case of death prior to retirement.

Retirement Estimate Request
Use this form to request a retirement estimate.
TERS Retirement Planning Checklist
Use this checklist to help you plan for retirement.

Retired Member Forms

Address/Name Change Form
Use this form to notify us of an address change or a name change. Name changes require legal documentation of the new name such as a social security card, driver's license, marriage certificate, or any subsequent court document.  

Electronic Deposit Authorization Form
Use this form to provide new or changed banking account information for direct deposit. A voided check must be attached to this form to ensure that we have your bank's proper routing address and your correct account number documented for your file.

Withholding Tax Form
Use this form to initiate or make a change in your withholding.

Withholding Tax Calculator
Use this calculator to determine your federal income tax withholding from your gross monthly pension. The calculator uses Microsoft Excel Version 97-2003 or later. If you don't have Excel, please call us and we will run the calculations for you.

Withholding Tax Tables
This document shows the IRS Circular-E 2017 Tax Tables. 

Beneficiary Designation Form
Use this form to designate a beneficiary for the payment of any pension benefits upon your death.  Please attach a copy of any wills and/or letters of testamentary designating an executor/executrix of your estate.

Affidavit of Domestic Partnership

Retired Member Medical and Dental Forms

Benefits Enrollment Change Form
Dependent Eligibility Form
Regence PPO Benefits Summary
Delta Dental Services Summary
Willamette Dental Services Summary