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Service Forms

Defined Benefit Program Forms

The forms below are supplied for general use by participants in the retirement fund. For city-specific forms, please contact your pension committee secretary. Pension committee secretaries may access city-specific form by logging in here.

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Withholding Form - Federal W-4P

Additional Credited Service

Address Change Form

Application for Participation - CONTRIBUTORY CITIES ONLY

Change of Name Request Form

Date of Birth Affidavit

Direct Deposit Authorization

Direct Deposit Cancellation Authorization

Disability Certification Form

Withholding Form - Georgia G-4P

Income Verification Request

Leave of Absence Report

Post-Retirement Death Benefit Checklist

Pre-Retirement Beneficiary Designation Form

Pre-Retirement Death Benefit Checklist

Proof of Birth Requirements

Retiree Address Change Form

Retirement Application Checklist

Retirement Application Form

Retirement Application Instructions

Salary Sheet

SAVE Affidavit

Firefighters' Cancer Benefit Program Forms

The forms listed below can be found at www.thehartford.com/gma-firefighters:

FAQ’s
How to File a Claim
Critical Illness Policy Booklet
Long-Term Disability Policy Booklet
Critical Illness Claim Form
Portability and Conversion Forms (for departing firefighters that want to continue LTD coverage)
Extended Continuation Form (for departing firefighters that want to continue Critical Illness coverage)
Notice of Continuation Form for LTD
Contact Sheet