Form 5W: Emergency Request to Waive Refund - PERS - MS 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Member Information section. Enter 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 box next to 'Public Employees’ Retirement System of Mississippi (PERS)'.
4. For Lump Sum Distribution Election, choose either 'Refund to Member' or 'Rollover Distribution'. If opting for a refund, specify any additional federal tax withholding amount.
5. Complete the Applicant Authorization section by signing and dating the form. Ensure you understand that accepting this refund waives all accrued vested rights in your retirement plan.
6. Finally, if required, have an authorized employer representative complete the Employer Certification section before submitting your form.

Start using our platform today to fill out your Form 5W quickly and efficiently!