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Pension Forms

The following is a list of Pension 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
Document
Description
In-Mail Request
Application to request a pension.
Application to request a pension annuity.
Enroll eligible beneficiaries of a deceased retiree in order to continue applicable benefits.
Miscellaneous Forms
Document
Description
In-Mail Request
Authorization for the Trust Funds to electronically send your monthly pension checks to your designated financial institution. Faster, convenient and more secure than mailing checks to an address.
Verification form for employers to determine if an employee or prospective employee would be working in employment prohibited by the Pension Plan.
Summary of Accumulated Credited Service & Benefit Units
A breakdown, by Plan Credit Year and a Total Accrual, of Credited Service and Benefit Units earned by the Participant.
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.
Information for drafting a Qualified Domestic Relations Order (QDRO) if the Participant is retired and procedures to determine and administer such an order.
Former Spouse Waiver of Interest in the Laborers Pension Plan of Northern California.
Tax Forms
Document
Description
In-Mail Request
Change your federal and/or state tax withholding deduction taken from each pension check.


Personal Information
(* Indicates a required field)

Name*
 
Health Plan ID
 
Address 1*
 
Address 2
 
City*
 
State/Province*
 
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.