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Annuity Forms

The following is a list of Annuity forms that can be requested from the Fund Office.

Some of the plan documents may be available for online viewing in the PDF file format. Adobe's Acrobat Reader® is required.

If you do not have Adobe’s Acrobat Reader® installed on your computer, click here to go to the Adobe website to download and install the most recent version.

If you would like the document mailed to you:

  1. Select the checkbox next to the document’s name (you can select as many different documents as you like).
  2. Once your selections are made, scroll down this page and comlete your personal information.
  3. When ready to send your request, click the Submit button to automatically send the Email request to our Customer Service section.
Benefit Application & Enrollment Forms
In-Mail Request
Application to request a pension annuity.
Miscellaneous Forms
In-Mail Request
Information for drafting a Qualified Domestic Relations Order (QDRO) if the Participant is not retired, Sample QDRO and procedures to determine and administer such an order.
Former Spouse Waiver of Interest in the Laborers Annuity Plan of Northern California.

Personal Information
(* Indicates a required field)

Health Plan ID
Address 1*
Address 2
ZIP/Postal Code*
Email Address
Telephone Number
TeleFAX Number


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.