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Pers form 5 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with the Member Information section. Fill in your first name, middle initial, last name, gender, social security number, birth date, email address, and mailing address where the refund check should be sent.
  3. In the Retirement Plan section, select the applicable plan by checking the appropriate box.
  4. For Lump Sum Distribution Election, choose either 'Refund to Member' or 'Rollover Distribution'. If opting for a rollover, ensure you complete Form 5C as required.
  5. Complete the Applicant Authorization section by signing and dating the form. Ensure you understand the implications of waiving your rights.
  6. The Employer Certification section must be filled out by an authorized employer representative. Ensure all details are accurate before submission.

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If you do leave CalPERS employment, the following two options are available to you: Take a lump-sum refund or rollover. This option includes a refund of your member contributions plus interest, but not any employer contributions made on your behalf.
You can refund your member contributions and interest if: Youve permanently separated from all CalPERS-covered employment. Your separation date must have been reported to us by your employer before we can begin to process your refund request. Youre not entering employment with a CalPERS-covered employer.
Regardless of the reason you separate, when you permanently leave CalPERS-covered employment you have options regarding the contributions in your account. Take a lump-sum refund or rollover. Leave the contributions and interest in your account.
An employee is automatically a member of PERS unless the employee elects ORP within 30 days of initial employment in an ORP- eligible position. Once made, the decision is irrevocable even if there is a break in service or the employee is hired in an ORP-eligible position at another Institution of Higher Learning.

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pers member refund

Forms Archive | PERS of Mississippi

All PERS forms are available for print, Active Member Refund - Direct Payment Distribution Form 5, Membership Refund Application Form 5,

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Form 5 Refund Application

Member Refund Application Form 5. Refunds are processed within 90 days of receipt of completed application or termination from last covered employment,

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