- Digital signatures are not accepted by NDPERS.
- Completed forms must be submitted to NDPERS by fax, by mail, or as a scanned PDF.
- NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.
Select a form to download:
For Dental & Vision Plans
- Retiree Vision/Dental Insurance Enrollment/Change (SFN 53504)
- Authorization for Automatic Premium Deduction (SFN 50134)
- Verification of Alternate Retirement Plan (SFN 53863)
- Application for Dependent Disability (SFN 58856)
- Grandchild Eligibility Verification (SFN 60983)
- Physician's Form for Dependent Disability [(SFN 58798)
For Vision Plan only
Other general forms