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LA LSERS Form 12C 2017-2025 free printable template

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1412C Form 12C8660 United Plaza Blvd. (70809) P.O. Box 44516 Baton Rouge, Louisiana 708044516 Phone: 225.925.6484 Toll free: 1.800.256.3718 Fax: 225.922.1001 www.lsers.net6/17PrintPhysician Report
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How to fill out LA LSERS Form 12C

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How to fill out LA LSERS Form 12C

01
Obtain the LA LSERS Form 12C from the official website or your local LA LSERS office.
02
Read the instructions provided with the form carefully.
03
Fill out your personal information, including your name, address, and employee identification details.
04
Provide information about your employment history, including positions held and duration of employment.
05
Complete the section regarding your beneficiaries and provide their details as required.
06
Review the form for any errors or omissions.
07
Sign and date the form at the designated area.
08
Submit the completed form to the appropriate LA LSERS office, either by mail or in person.

Who needs LA LSERS Form 12C?

01
Employees of the City of Los Angeles who are members of the Los Angeles City Employees Retirement System (LA LSERS) and are applying for retirement benefits or related services.
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LA LSERS Form 12C is a form used by the Louisiana State Employees' Retirement System (LSERS) to report various employment and payroll-related information for employees who are members of the retirement system.
Employers who have employees participating in the Louisiana State Employees' Retirement System are required to file LA LSERS Form 12C.
To fill out LA LSERS Form 12C, employers must provide accurate information regarding employee earnings, service credit, and other specified data as outlined in the form's instructions.
The purpose of LA LSERS Form 12C is to ensure that the retirement system has accurate and up-to-date information for calculating retirement benefits and maintaining member records.
Information that must be reported on LA LSERS Form 12C includes employee identification details, earnings, hours worked, service credit, and any other relevant employment information as required by the retirement system.
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