Central Laborers' Pension Welfare & Annuity Funds
Online Forms Gallery (Adobe Acrobat Reader Required)

 

 

 


Pension Forms

IRS 2017 Form W-4P

Affidavit in Support of Claim for Death Benefits

Application for Pre-Retirement Surviving Spouse Option

Beneficiary Designation Form

Cancellation of Pre-Retirement Surviving Spouse Option

Deduction of Union Dues Form

Direct Deposit Form

Disability Benefit or Occupational Disability Benefit Application

Medical Release Form

Pension Application

Pension Death Benefit Application

Proof of Age Form

Proof of Disability Form

Return to Work Form

Return to Retirement Form

Suspend Pension Benefits Form

Local Union Release of Personal Information

Outside Fund Release of Personal Information

General Forms

Change of Address

Employer Forms

Remittance Report Form
Welfare Forms

Accident Report Form

Appeal Procedure

Application for Welfare Non-Work Disability Credit

Beneficiary Designation Form

CVS/Caremark Mail Service Order Form

Dental Claim Form

Proof of Adult Child Relationship Form

Life Insurance / Accidental Death Application

Loss of Time Application

2012 Open Enrollment Form

2013 Open Enrollment Form

2014 Open Enrollment Form

2015 Open Enrollment Form

2016 Open Enrollment Form

2017 Open Enrollment Form

2015 Open Enrollment Coverage Change Form

2016 Open Enrollment Coverage Change Form

2017 Open Enrollment Coverage Change Form

Health Reimbursement Account (HRA) Claim Form

Release of PHI (Personal Health Information)

Vision Care Claim Form

Well Child Care Covered Immunizations

Annuity Forms

Affidavit in Support of Claim for Death Benefits

Annuity Application

Beneficiary Designation Form

Death Benefit Application

Direct Deposit Form

Annuity Hardship Application

Tax Notice Regarding Plan Payments


Local Union Release of Personal Information

Outside Fund Release of Personal Information

 


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