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FORMS FOR ALL FUNDS
Enrollment Form
Change of Address Form

FORMS FOR HEALTH & WELFARE FUND
-- Select a Form -- Medical Claim Prescription Claim (Active) Prescription Claim (Pensioner) Weekly Disability Physician Supp. Cert. HIPAA Authorization HIPAA Cancellation HIPAA Request for PHI Student Break Eligibility

FORMS FOR RETIREMENT FUND
-- Select a Form -- Basic Pension Application Retirement Declaration Disability Declaration Explantion and Election of Form of Benefit State Income Tax Witholding Automatic Deposit Authorization Election & Authorization for H&W Deductions Waiver of 30 Day Waiting Period Notice regarding right to defer

FORMS FOR VACATION & HOLIDAY FUND
Interim Withdrawal Form
Emergency Withdrawal Form
Monthly Benefit Election Form

FORMS FOR DEFINED CONTRIBUTION FUND
Due to the transition from SelectBenefit to Prudential, please contact the fund office at 800-595-7473 ext. 283 or ext. 267 to obtain forms.

BY MAIL
To request for forms, please call the Fund Office at
1-800-595-7473 or email request to forms@scptac.org.