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Complete an Enrollment Form

Have you ever experienced the frustration of having a claim denied because of incorrect or incomplete information on your Enrollment Form?

Although it may seem insignificant, your Enrollment Form is one of the most important documents used by the Fund Office in providing benefits to you and your family. By keeping your Enrollment Form current, you should not have to endure any unnecessary delay in the payment of your benefits.

When to complete an Enrollment Form

Complete your first form when you start working as a Laborer; be sure to include all eligible dependents. After that, each time your family status changes, complete and submit an updated Enrollment Form. Changes in family status include marriage; birth or adoption of a child; custody of a stepchild; and divorce. When you submit an updated Enrollment Form, you must complete the entire form, as your new form replaces the old one.

Participant Information Section: Enter your (the Laborer’s) social security number and name--first, middle, and last (always PRINT clearly and legibly). Enter your mailing address, including zip code. The next line asks for your telephone number, E-mail address (if any) and Local Union. The last line asks for your date of birth, sex and and marital status.

Dependent Information Section: Enter the names of your eligible dependents. If the last name is different from yours, also enter the last name. Enter each dependent’s date of birth, social security number, and relationship to you.

Required documents must accompany the Enrollment Form when you add a dependent. Note that we only require you to send the document at the time you add the dependent. For example, if you marry, we ask that you send your marriage certificate with your Enrollment Form. If, at a later time you have a child, you would only be required to submit a birth certificate for your child; you would not be asked to resubmit the marriage certificate.

Beneficiary Information Section: In the next section, you are asked to identify your beneficiary. Include the beneficiary’s social security number, first, middle, and last name, their relationship to you (spouse, child, parent, or friend) and their mailing address.

Participant Statement Section: Date and sign the form.

Be sure to write your (the Laborer’s) social security number on any documents you submit with your Enrollment Form.

It should be noted that the Enrollment Form applies for all the Trust Funds. As a Laborer, you have accrued and continue to accrue health and welfare, vacation-holiday, pension and annuity benefits. By maintaining an updated Enrollment Form, you can avoid any unnecessary delays in the payment of these benefits to you, your eligible dependents, and your beneficiary.

To request an Enrollment Form: print form online, or contact the Fund Office, or visit your Local Union Office.

Copyright ©2003; Laborers Funds Administrative Office of Northern California, Inc. All rights reserved.
Derechos Reservados Propiedad Literaria ©2003, La Oficina Administrativa de Fondos de los Obreros del Norte de California, Inc.