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Here you will find the most current versions of the forms used by PEBA Retirement Benefits. To use our forms, you will need to have the Adobe Acrobat Reader installed on your computer.

Description Number
ACH Debit Authorization 1226
Adjustment to Quarterly Payroll Report (South Carolina Retirement System, Police Officers Retirement System) 1223
Administrative Appeal Disability Report 6291
Application to Append Coverage for Incidental Death Benefit (SCRS) 6502
Application to Append Coverage for Incidental Death Benefit, Accidental Death Program And/Or Firefighters Coverage (PORS) 6502P
Authorized Representative Form 7213
Beneficiary Form - Beneficiary Designation, Contingent Beneficiary (All Systems) 1102
Beneficiary/Trustee Designation Form (All Systems) 1103
Certification of Nonexistent Trust (All Systems) 4257
Certification of Trust (All Systems) 1113
Change of Address 1117
Deduction Form, Public Safety Officer Insurance Payment Program - EIP Only 7700
Deduction Form, Public Safety Officer Insurance Payment Program - Non-EIP 7701
Deferred Annuity Account (JSRS) Payout Form 7800
Direct Deposit Authorization 7204
Due Date Calendar 1341
Election of Non-Membership 1104
Electronic Employer Services (EES) Authorizing Contact Designation/Agreement 6504
Electronic Employer Services (EES) Designated Agent Confidentiality Agreement 6505
Electronic Employer Services (EES) Employer Confidentiality Agreement 6503
Employer Certification of Police Officers Retirement System (PORS) Eligibility 1107
Employer Eligibility Determination Request 6500
Employer Resolution And Application (PORS) 6501P
Employer Resolution And Application (SCRS) 6501
Employer Resolution on Tax Deferred Payroll Deductions for Installment Purchase 3228
Employer's Disability Employment Status Report 6253
Enrollment Form (All Systems) 1100
Fiscal Year Contribution Rates 1340
General Assembly Retirement System Application for Service Retirement Benefits 6101G
General Assembly Retirement System Special Contributing Member Election 2140
Installment Service Purchase Remittance 3229
Judges and Solicitors' Retirement System Application for Service Retirement Benefits 6101J
NGRS Service Retirement Application 6101N
Police Officers Retirement System Application for Disability Retirement 6151P
Police Officers Retirement System Application for Service Retirement Benefits 6101P
Refund Request (South Carolina Retirement System, Police Officers Retirement System) 4101
Request for ORP Service Verification (Applies to ORP service in South Carolina only.) 2130
Request for Public/Educational Service Verification 2122
Request for Retirement Benefit Estimate (All Systems) 6100
Request for Service Purchase Cost (All Systems) 2101
Requirements for a Participant to Revoke Election to Participate 3227A
Retired Member Change of Beneficiary (South Carolina Retirement System, Police Officers Retirement System) 7201
Retired Member Change of Beneficiary Form (GARS) 7201G
Retiring Member's Disability Applications Checklist 6352
Retiring Member's Service Application Checklist 6302
Service Purchase Federal Address List 2391
Service Purchase Payment Options (All Systems) 2390
Service Purchase Salary Verification 2209
South Carolina Retirement System Application for Disability Retirement 6151S
South Carolina Retirement System Application for Service Retirement Benefits 6101S
Standard Retirement Quarterly Report - Class I Employer (South Carolina Retirement System, Police Officers Retirement System) 1222
Standard Retirement Quarterly Report (South Carolina Retirement System, Police Officers Retirement System) 1221
State Optional Retirement Program (ORP) Active Incidental Death Benefit Beneficiary Form (South Carolina Retirement System) 1106
State Optional Retirement Program (State ORP) 1162
Supplemental Contribution Report (After 07/01/2005) 1227
Supplemental Service Report (South Carolina Retirement System, Police Officers Retirement System) 1224
Teacher and Employee Retention Incentive (TERI) Payout Election Form 7500
TERI Program Reminders 6376
Withholding Certificate for Monthly Benefit Payments 7202