PERS Member Withdrawal Application Instructions
This file provides essential information and instructions for Oregon’s PERS Member Withdrawal Application. It outlines withdrawal eligibility, necessary forms, and submission guidelines. Users should read carefully before completing and submitting the application.
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How do I fill this out?
To fill out this application, ensure you have all necessary personal information at hand. Begin by carefully reading all sections to understand your account options and requirements. Check the eligibility criteria and complete the form diligently.

How to fill out the PERS Member Withdrawal Application Instructions?
1
Read through the instructions carefully.
2
Fill in your personal information accurately.
3
Select your account withdrawal options.
4
Provide required documents for verification.
5
Submit the completed form and documents as instructed.
Who needs the PERS Member Withdrawal Application Instructions?
1
Oregon PERS members looking to withdraw their funds.
2
Individuals who have separated from their PERS employers.
3
Judges or alternate payees seeking account withdrawals.
4
Current members considering retirement options.
5
Employees needing to transfer their accounts.
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What are the instructions for submitting this form?
To submit this form, complete all sections accurately and ensure all required documents are attached. You can mail your completed forms to PERS at PO Box 23700, Tigard, OR 97281-3700. Alternatively, you may fax forms to 503-598-0561 or deliver them in person to 11410 SW 68th Parkway, Tigard, OR 97223. Ensure to keep a copy for your records. Always verify the latest information and any updates on submission guidelines.
What are the important dates for this form in 2024 and 2025?
It is important to submit your withdrawal application by the end of the month to ensure processing within the effective withdrawal date timeframe. Make sure to check any updates on deadlines that may arise in 2024 and 2025 for processing your submission.

What is the purpose of this form?
The purpose of this form is to facilitate the withdrawal process for members of the Oregon PERS program. It provides clarity on eligibility, necessary documentation, and instructions for properly completing the withdrawal application. This form ensures that members make informed decisions about their retirement funds and that their requests are processed efficiently and accurately.

Tell me about this form and its components and fields line-by-line.

- 1. Member Information: Includes personal details such as your full name, PERS ID, and Social Security Number.
- 2. Withdrawal Selection: Allows you to choose which accounts you want to withdraw from.
- 3. Withdrawal Payment Options: Lets you select how you wish to receive your withdrawal funds.
- 4. Verification of Age: Requires documentation proving your age as part of the withdrawal process.
- 5. Signature: Space for your signature affirming the accuracy of the information provided.
What happens if I fail to submit this form?
If you fail to submit this form, you will be unable to access your withdrawn retirement funds. It is crucial to follow the outlined instructions to avoid complications in your application process.
- Delayed Processing: Missing or incomplete forms can significantly delay your application.
- Loss of Funds: Not submitting the form may result in the inability to withdraw your funds.
- Potential Fees: In some cases, failing to complete the process correctly can lead to additional fees.
How do I know when to use this form?

- 1. Post-Employment Withdrawal: For those who have terminated their employment and want access to their retirement funds.
- 2. Judicial Account Withdrawals: Specific withdrawals for judges or alternate payees managing separate accounts.
- 3. Rollover Transfers: To initiate rollovers directly to another qualifying account.
Frequently Asked Questions
What is the purpose of this form?
This form allows Oregon PERS members to withdraw their retirement funds under specific eligibility criteria.
Who is eligible to use this form?
Any Oregon PERS member who has separated from their employers and wishes to withdraw their account is eligible.
How do I submit the completed form?
You can mail, fax, or deliver your completed form to the designated PERS addresses.
What documents do I need to submit with the form?
You need to provide the completed application form and any required verification documents.
How long does it take to process my application?
Most applications will be processed within 120 days from your effective withdrawal date.
Can I restore my membership rights after withdrawal?
Yes, you may restore your rights if reemployed in a PERS-qualifying position within five years.
What happens if I change my address after submission?
Notify PERS immediately to ensure you receive your IRS 1099-R forms at the correct address.
Are there any fees for processing my withdrawal?
Typically, there are no direct fees, but ensure your application is complete to avoid delays.
Can I edit this PDF form?
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Is digital signing available for this form?
Yes, you can sign the PDF digitally on PrintFriendly before submission.
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