Pension Deduction Authorization

This online form is for enrolling in the LACERS pension deduction program. Only submit the form if you are a City Retiree.

If you work for a different municipality, please click here and scroll down to the employee affiliation section to sign up using the appropriate deduction authorization.

Manual Processing:

If you prefer to fill out the pension deduction form manually, you can download it here. Once completed, you can email form to help@employeesclub.com or by mail. Note: Manual processing will take longer.

First Name

Middle Initial

Last Name

Email Address

Phone Number

Gender

Marital Status

Date of Birth

Last Four of SSN

Mailing Address

Please sign below:

I hereby authorize the deduction from my salary or pension of amounts sufficient to cover premiums/membership fees on any of my group benefits provided by the Employees Club of California. In the event any premiums should change due to age, increase in salary or benefits, or a general rate increase for the entire Association, I authorize you to make such change upon notification from the Employees Club of California and such deduction to remain in force until canceled by me in writing.

By clicking Submit below, you agree to our Terms and Conditions.

Pension Deduction Authorization

Please sign below:

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