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Forms

New Forms with Bar Codes
LASERS can accept only the original forms (printed from Form Management or downloaded from this site) -- no photocopies or faxed forms. All of these forms are best if printed with a color printer. Check each form to see if you need to make multiple copies. Follow the instructions and always make a copy of the completed form for your records.

All files are in the Adobe Acrobat Portable Document Format (PDF). You must have Adobe Acrobat Reader installed on your computer. The Adobe Acrobat Reader© can be downloaded FREE OF CHARGE from Adobe's Internet site.

Agency Human Resource Personnel
Please note that LASERS forms requiring certification and signature by the appointing authority are now located under Agency Information on the website. Contact your agency liaison officer for the user name and password. Forms not requiring Agency participation are also listed for your convenience.

Members
The forms listed below as Fillable Forms may be filled in on screen, printed, signed and certified, and sent to LASERS. Please note that dates may be required to be entered in the following format (MM/DD/YYYY)

If you wish to use the fillable Change of Address form 1-2, please visit the secured “Order PIN/logon” area of the “Active Employees” or “Retired Employees” sections. You can order a PIN number at this secured site. You will need your Personal Identification Number (PIN) to use the secured Change of Address form.

Order PIN / Logon

Legal Forms
Limited Power of Attorney

Fillable Forms

No. Form Name
01-02 Change of Address
01-06 Designation of Beneficiary
01-07 Change of Name
02-01A Authorization for Direct Rollover
02-03 Application for Reciprocal Recognition of Service
02-04 Application for Transfer of Creditable Service
02-05 Certification for Purchase of In-State Service
02-06 Application for Purchase of Military Service
02-07 Application for Purchase of Service R.S. 11 429 (B) (Benefit Computation Purposes Only)
02-08 Application for Purchase of Certain Service by Legislators
02-11 Application for Repayment of Refunded Service
02-12 Application for Repayment of Refunded Service to Reciprocate/Transfer
02-13 LASERS Acceptance Letter of Rollover of Assets
02-14 Legislative Upgrade Invoice Request
02-15 Judicial Upgrade Invoice Request
02-16 Request for Research of Refundable Contributions
04-01 Disability Retirement
04-01A Option 2B Mentally Handicapped Designee
04-02 Selection of Disability Retirement Plan
04-03 Disability Retiree Earned Income Statement
04-04 Spousal Consent Form
04-05 Authorization for Direct Deposit
05-01 Request for Retirement Benefit Estimate
09-03 Request for Withdrawal from DROP-IBO
09-04 Transfer to Self-Directed Plan
10-01 Beneficiary Signature
10-03 Public Safety Officer Authorization for Insurance Premium Deduction
10-04 Retired Public Safety Officers Insurance Carrier Agreement
15-01 ORP Enrollment Application
15-01A ORP Defined Contribution Plan Transfer to LASERS Defined Benefit Plan
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2006 Louisiana State Employees' Retirement System - LASERS, All rights reserved.