When you begin working for a contributing employer, it is very important that you complete an Enrollment Form in order for the Fund Office to have your most up-to-date and complete information.  Keep in mind, this form also includes your beneficiary information, your dependent information, and much more... Please make time to complete and submit this form.
 

Adobe Reader is a free utility that allows you to read and view PDF files.

Welcome to the Participant Downloads resource page.  The links below provide you the official forms and documents used by the Fund Office.

These are separated by general Union membership to the benefit Funds.  Simply click the filename and it will open in your browser.

To save the file, right click on the filename of your choice and choose the "Save Target As..."

• Transfer Authorization Request
• Pipeline Transfer Authorization Form
• Central Pension Fund Transfer Authorization
   
• Building Trades Agreement (2008-2012)
• Heavy/Highway Agreement (2010-2012)

• Enrollment Form
• Beneficiary Designation Form
• Information Change Request Form
• General Glossary of Investment-Related Terms
  
  Applications
• Distribution/Direct Rollover Application
• Hardship Withdrawal Request
• Alternate Payee Distribution
• Death Benefit Claim Request
• Spousal Consent Form
• Certification of Disability
   

Download your Annuity SPD
 

• Address Change
• Enrollment Form
• Beneficiary Designation Change
   
• Accident/Injury Claim Form
• Dental/Vision Care Benefit Form
• Supplemental Disability Claim Form
• Subrogation Agreement
  
  Participant Privacy
• Notice of Privacy Practices
• Authorization to Disclose Protected Health Information (PHI)
  
  Dearborn National Life Insurance
• Group Insurance Certificate (Active Participants)
• Group Insurance Certificate (Non-Medicare Retirees)
  
  Medicare Supplemental Plan Coverage
• Medicare Notice of Creditable Coverage (October 2012)

Download your
H&W SPD

 

N E W...

Download your Uniform Summary of Benefits and Coverage

Download your Glossary of Health Coverage and Medical Terms
 

• Address Change
• Beneficiary Designation Change
• Rejection of the Qualified Survivor Benefit
• Reversion of the Rejection of the Qualified Survivor Benefit
  
  Applications for Retirement
• Notification of Retirement Application
• Notification of Retirement Application for Alternate Payee (QDRO)
• Notification of Retirement Application (Survivorship)
  
  Benefit Updates
• Direct Deposit (ACH Transfer) Application
• Federal Tax Withholding
• WV State Tax Withholding
  
  Notices
• Special Tax Notice
   

Download your Pension SPD