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San Mateo County Employees' Retirement Association
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MySamCERA

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Are you getting ready to retire?
There are some important things inactive members should know about retirement

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Learn more about your COLA
Get this year's cost-of-living adjustment (COLA), plus find out how COLA is calculated

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Get an accurate retirement benefits estimate
Login to MySamCERA for the most accurate look at your future pension

Forms and Publications

Member Forms

Overview

Member Forms

Choose a form below. The form will open on your screen. Use the print menu on your computer to print the form. Mail your completed, signed form to SamCERA.

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Address Change Form
this form is for Retired and Inactive Members only

Active members should use Workday to update their contact information.  

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Beneficiary Designation Form
This form is for Active and Inactive Members only

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Beneficiary Designation Form
This form is for Retired Members only

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Direct Deposit Form

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Disposition Form

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Domestic Relations Order: Model Order A

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Domestic Relations Order: Model Order B

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Domestic Relations Order: Model Order C

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Domestic Relations Order: Model Order D1

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Domestic Relations Order: Model Order D2

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Lost or Destroyed Check Affidavit

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Reciprocity Request Form

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Rollover Transfer Certification Form

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Service Purchase Request Form

Download the PDF

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Tax Withholding Form – Federal

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Tax Withholding Form – CA

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Transfer to Contributory Plan Form

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Do you have a question for SamCERA?
Call or send us an email.