H&W - Direct Debit for Retiree Medical Coverage Form
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Last Updated: 06/28/2007
File Size: 29.48 KB
Hits: 1 |
| Central PA Teamsters Health & Welfare Form to be used to request an automatic monthly withdrawal of funds, from a checking or savings account, to pay the monthly Retiree Health & Welfare premiums.
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H&W - Student Verfication Letter
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Last Updated: 06/28/2007
File Size: 35.52 KB
Hits: 1 |
| Central PA Teamsters Health & Welfare Fund letter to verify that a dependent child between the ages of 19 and 23 years is a Full-time student at an accredited higher learning institution.
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H&W - Member's Application for Benefits Form
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Last Updated: 06/28/2007
File Size: 44.96 KB
Hits: 11 |
| Central PA Teamsters Health & Welfare Fund form to apply for short-term disability benefits.
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H&W - Application/Beneficiary Form
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Last Updated: 06/28/2007
File Size: 25.68 KB
Hits: 7 |
| Form used to add or delete dependents eligible for benefit coverage with Health and Welfare and beneficiary(ies)listing for your Death and Accidental Death and Dismemberment benefits.
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H&W - Davis Vision Direct Reimbursement Claim Form
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Last Updated: 06/28/2007
File Size: 24.07 KB
Hits: 2 |
| Davis Vision reimbursement claim form.
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H&W - Stepchild Certification Form
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Last Updated: 06/28/2007
File Size: 26.29 KB
Hits: 2 |
| Central PA Teamsters H&W Fund Form to certify that your stepchild is a full-time resident and You do or will claim this child as a dependent on your Federal Income Tax Return.
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H&W - Coordination of Benefits (COB) Form
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Last Updated: 06/28/2007
File Size: 96.18 KB
Hits: 3 |
| Central PA Teamsters H&W Form used to coordinate benefits with your spouse or the Natural Mother/Father of your child(ren).
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Honorary Withdrawal Card Form - Illness
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Last Updated: 06/28/2007
File Size: 25.09 KB
Hits: 3 |
| Withdrawal Card Form to be used when you off work for any full calendar month for an injury or illness.
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Change of Address or Phone Number Form
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Last Updated: 06/28/2007
File Size: 23.04 KB
Hits: 2 |
| Form to be used to be used to submit a change to your address or phone number.
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Honorary Withdrawal Card Form - Termination
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Last Updated: 06/28/2007
File Size: 24.58 KB
Hits: 6 |
| Withdrawal Card Form to be used when either terminated or laid off from your employment.
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