Forms

What type of form do you need?

Forms

Forms for Members

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

Retirement Application Kit
* Be sure to include a completed copy of the Federal W-4P Form with your completed Retirement Application Kit.

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.

Forms

Forms for Retirees

Beneficiary Designation Form

Direct Deposit Authorization Form

Federal W-4P Tax Withholding Certificate

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

Retirement Application Kit

State of Idaho Tax Withholding Form

Third-Party Verification Request