Get Enrollment Change Request Form - Arkansas Public Employees ... - Apers

The Enrollment Change Request Form is an essential document for members of the Arkansas Public Employees' Retirement System (APERS) who need to update their enrollment information. This guide provides clear and detailed instructions to help you complete the form accurately and efficiently online.

Follow the steps to fill out the Enrollment Change Request Form online.

1. Press the ‘Get Form’ button to obtain the Enrollment Change Request Form and open it in the editor.
2. Fill out the Member Information section, including your Social Security Number, full name (Last, First, Middle Initial), mailing address, city, state, zip code, APERS employer number, and APERS employer name.
3. In the Contact Information Change section, provide your updated mailing address, city, state, zip code, email address, and daytime telephone number.
4. Complete the Personal Data Change portion by entering your new last name, first name, marital status (indicate if married, divorced, or widowed), middle initial, spouse's name (or ‘None’ if applicable), spouse's date of birth, and gender.
5. For the Beneficiary Designation Change, input the Social Security Number, name, date of birth, relation, and gender for each beneficiary you wish to designate.
6. In the Member Certification section, sign and date the form to confirm that you understand the changes you are requesting and that they are not for deceptive purposes.
7. If you have changed any beneficiary information, complete the Notary Public Acknowledgement section by having a notary public witness your signature and provide their seal.
8. Lastly, save changes, download, print, or share the completed form as necessary before submitting it according to the submission guidelines.

Complete your Enrollment Change Request Form online today for a seamless experience!