Exhibits - Section 5

Exhibits - Section 5

 

Exhibit 5A Form 5.10 Application for Separation Refund (e-form also available)

Exhibit 5B Form 5.20 Application for Retirement Annuity (Pension)

Exhibit 5C Form 5.21 Notice of Intent to Retire Under Employer’s Early Retirement Incentive

Exhibit 5D Form 5.30 Application For Death Benefit 

Exhibit 5E Form 5.40 Application for Disability Benefits

Exhibit 5F Form 5.41 Employer’s Statement -- Disability Claim

Exhibit 5G Form 5.42 Physician’s Statement -- Disability Claim

Exhibit 5H Form 5.45 Employer’s Notice of Trial Work Period or Termination of Disability 

Exhibit 5I  Form 5.48 Disability Payment Agreement Exhibit

Exhibit 5J  Form 7.10 Health Insurance Premium Deduction Authorization

Exhibit 5K Form 1199 Authorization for Deposit of Illinois Municipal Retirement Fund Payments 

Exhibit 5L Form BW-60 Distribution/Rollover Certification

Exhibit 5MA S-40 Certificate of Benefits for IMRF Pension 

Exhibit 5MB  S-40 Certificate of Benefits for Surviving Spouse Annuity

Exhibit 5N Form 7.12D Election For Pre-Tax Deductions for Health or Long Term Care Insurance Premiums Paid Directly to Insurer

Exhibit 5O Form 7.12E Election For Pre-Tax Deductions Health or Long Term Care Premiums Paid through Employer or Endorsed Plan Administrator

Exhibit 5P Form 3.01 Change Account for Electronic Payments from IMRF 

Exhibit 5Q Tier 1/Tier 2 Comparison Chart for IMRF Regular Plan and ---- Tier 1/Tier 2 Comparison Chart for IMRF SLEP Plan

Exhibit 5R Return to Work and Effect on Tier 1 and Tier 2 Members Chart

Exhibit 5S Public Act 98-0389 Return-to-Work Rules: A guide for Retired Members