Member Forms

Use this form if you are a member of ERSRI/MERS who has separated from employment and want to request a refund of your contributions. Important note: This form should not be submitted until AFTER your final date of employment. Forms submitted before that date cannot be processed.

Use this form if you have already submitted an Application for Termination from ERSRI and want to roll your contributions into another qualified retirement plan. 

Use this form to tell ERSRI who you would like to name as your primary and contingent beneficiaries or to change your designated beneficiaries. Also use this form to add your spouse.

If you worked after June 30, 2012 within ERSRI, don't forget to also update your beneficiaries with TIAA. To change your TIAA beneficiary online, please visit www.tiaa.org/beneficiary. If you need further assistance with your TIAA beneficiary designation, please contact TIAA at (800) 842-2252.

Use this HARTFORD Life Insurance Beneficiary Designation form if you would like to name a new beneficiary on your HARTFORD policy. This form must be sent directly to the HARTFORD Insurance address located on the form. 

Use this form to report a name change, new e-mail address, or change of telephone number. Note: If you are an active member, report your address change directly to your employer.

Use this form to inform ERSRI about your Domestic Partnership or the termination of a Domestic Partnership. 

Use this form to request verification of your retirement eligibility or a benefit estimate. Note: If you are within five (5) years of retirement complete the Counseling Request web form instead.