Application For Retirement

Base Plan Account Withdrawal Form
* Do not submit this form until you have terminated all employment with PERSI-covered employers

Beneficiary Designation Form

Choice 401(k) Plan Paycheck Contribution Election

Member Mailing Address Change Form
* If you are still working for a PERSI employer, your address must be updated through your employer’s payroll transmittal.

Member Name Change Form
* If you are still working for a PERSI employer, your name must be updated through your employer’s payroll transmittal.

PERSI Durable Limited Power of Attorney Form

Release of Information Form

Request For Account Information By Spouse or Former Spouse Form

Social Security Quote Certification

Third-Party Verification Request

* All other Choice 401(k) Plan forms are available by calling Empower Retirement at 1-866-437-3774 or by logging into your Choice 401(k) Plan account. You can log in to your Choice 401(k) Plan account either via the link in your myPERSI account or directly to the Choice 401(k) Plan website.