.  Medicare Part-D  . 


Forms
Our commonly requested forms are available to you via download or mail.
 


To view and/or print online, you  will need Acrobat Reader. If you do not have Adobe Reader, click on the icon, to obtain a free download of Acrobat Reader.

ALL FUNDS Enrollment & Beneficiary Form
  Change of Address Form
HEALTH & WELFARE FUND Pacificare Enrollment
  Delta Dental Enrollment
  ULLICO Enrollment
RETIREMENT FUND Distribution Election Form
  DCP Enrollment/Change Form
VACATION & HOLIDAY Interim Withdrawal Form


To request forms, please call the Fund Office at 1-800-595-7473.