Downloadable Forms

Important Note About Our Downloadable Forms!

All forms available on the SJCERA web site are stored in Adobe Acrobat Reader "PDF" format for your convenience.

So what is a PDF formated file? Well, a PDF (Portable Document File) is an internet standard file format for Macintosh, Windows, DOS, and Unix computers.

After you download a PDF file, you can open, view and print it to your printer using a FREE application called "Adobe Acrobat Reader".

HOW DO I GET ADOBE ACROBAT READER?

To download Acrobat Reader, go to this web address: http://www.adobe.com/prodindex/acrobat/readstep.html

Active Employees': An employee that is currently working for San Joaquin County and making Contributions to SJCERA.
Select A Form Below to Download:	Size	Comments
Additional Service Credit Form	23K	Complete this form to initiate purchase of service credit costs.
Beneficiary Form Instructions Beneficiary Designation	63K 47K	Complete to change your beneficiary for retirement contributions, and/or death benefits.
Justification for Non-Signature of Spouse	95K	`Justification for Non-Signature of Spouse` If you are legally married and your spouse's signature does not appear on your SJCERA Beneficiary Designation form, you MUST complete and sign this form and submit it with your Beneficiary Designation form.
Member Enrollment Form	48K	Complete this form to provide the retirement association with your personal information. This is mainly used for new employees.
Request for Estimate Form	36K	Complete this form for a projection of your unmodified service retirement allowance.
Request for Social Security Statement (Form SSA-7004)	132K	Use the link to the left to access the forms section of the Social Security website, then search for form "7004."

Retirees': An enrolled retired employee who receives monthly retirement benefits from SJCERA retirement system.
Select A Form Below to Download:	Size	Comments
Change of Address	12K	Only for Retired and Deferred Members.
EFT Form	41K	Complete this form to have your retirement check electronically deposited into your bank account. Click link for Information on `Electronic Funds Transfer`
Tax Withholding	212K	Complete this form if you wish to have or change federal or state tax withholdings from your retirement check. Please check with your tax consultant or IRS Publication #575 if you need help calculating your tax liability.
Medicare B New Enrollment Medicare B Renewal	76K	-Complete this form if you wish to use your sick leave bank to reimburse your Medicare B payments. - Complete this form if you wish to ENROLL or RENEW your participation in the Medicare B reimbursement - Signed form must be return to SJCERA with a copy of signed Medicare card.
2013 Open Enrollment Packet	1.2M	Retiree Open Enrollment March 4 - March 29, 2013 Completed enrollment forms must be returned to SJCERA by Friday March 29, 2013

Deferred: A member that leaves their retirement contributions on deposit with SJCERA following separation from employment with the county.
Select A Form Below to Download:	Size	Comments
Additional Service Credit Form	23K	Complete this form to initiate purchase of service credit costs.
Change of Address Form	12K	Only for Retired and Deferred Members.
Beneficiary Form Instructions Beneficiary Designation	63K 47K	Complete to change your beneficiary for retirement contributions, and/or death benefits.
Justification for Non-Signature of Spouse	95K	`Justification for Non-Signature of Spouse` If you are legally married and your spouse's signature does not appear on your SJCERA Beneficiary Designation form, you MUST complete and sign this form and submit it with your Beneficiary Designation form.
Request for Estimate Form	36K	Complete this form for a projection of you unmodified service retirement allowance.

Domestic Relations Order: A state court judgement decree or order (including approval of a property settlement agreement) which relates to the provision of child support, alimony payments, or marital property rights to a spouse, former spouse, child or other dependent of a participant that is not yet qualified.
Select A Form Below To Download:	Size	Comments
Model DRO "A" Template	18K	`Domestic Relations Orders`
Model DRO "B" Template	18K	These are sample templates of acceptable domestic relation orders.

Last modified: Thursday, February 28, 2013