Forms for Pension Recipients | Forms for Participants (not Pension Recipients)

These printable forms are in PDF format. You need the Adobe Acrobat Reader to read and print them. If you do not have Adobe Acrobat Reader installed in your system, you need to install it by clicking on the download icon.

 

Address Change Form - Complete this form to change the address for your pension checks, retiree healthcare benefits and all mailings from the Funds.   

Address Temporary Change Form - Complete this form to temporarily change the address for your pension checks, retiree healthcare benefits and all mailings from the Funds. You must indicate a termination date for the temporary address, so that the Fund Office can reinstate your permanent address on the requested termination date. 

Annual Statement - This form must be completed by all pension recipients between January 1st and May 15th of each year. Failure to return this form and respond to reminder notices sent in April and May will result in a hold on your June pension check or direct deposit. 

Annual Statement with Witnesses - This version of the Annual Statement form can be completed by any pension recipient who is physically unable to appear before a Notary Public. This version requires that two witnesses certify your signature. These two witnesses cannot be your relatives and must list their contact information on the form. 

Citizenship Form - Complete this form if you move out of the United States. There are special federal income tax withholding requirements for non-residents that the Fund Office will determine after your declare your citizenship. 

Death Benefit Before 5/31/02 Beneficiary Form - Complete this form to change your beneficiary for death benefits from the Laborers' Welfare Fund for all pensioners who retired prior to May 31, 2002 and have a $4000 death benefit with the Laborers' Welfare Fund. Please contact the Fund Office to verify your eligibility. 

Death Benefit After 6/1/02 Beneficiary Form - Complete this form to change your beneficiary for death benefits from the Laborers' Welfare Fund, if included with your pension, for pensioners who retired after June 2002 and were eligible for the Retiree Medical Plan, and have a $6500 death benefit with the Laborers' Welfare Fund. Please contact the Fund Office to verify your eligibility. 

Direct Deposit Authorization Form - Complete this form to request that your pension checks be directly deposited into your bank account or to change the bank account currently used by the Fund. Return this form with a voided check or deposit slip for the requested account. The requested account must be in your name and can include joint account holders, who must also sign the form. Follow the instructions carefully when completing this form, incomplete forms will be returned. 

Disqualifying Employment Determination Forms - Complete this form to obtain a determination about whether a potential job would be considered Disqualifying Employment. There are two questionnaires included; one must be completed by you and another by your potential employer. Whenever possible, you or the employer should attach a detailed job description. 

Indemnity Agreement - Complete this form to stop payment on a missing pension check and request replacement on any check that you have not received by the 7th of the month. You should still call the Fund Office to report your check as missing, as it may have been returned to the Fund due to an unreported address change or held by the Fund to obtain required Annual Statement. 

IRS Form W-4P Withholding Certificate - Complete this form to change the federal income tax withholding on your pension payments. If you submit a change, it will be implemented no later than the January 1, April 1, July 1, or October 1 after we receive the form, provided we receive it at least 30 days before the date. 

IRS Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding - Complete this form to waive the automatic federal income tax withholding on pension payments to "Non-Resident Aliens" or non-US citizens, collecting pension while residing in another country, as allowed under the income tax treaty between the United States and that country. Please note that residents of some countries will not be allowed to waive the federal income tax withholding. Please contact the Fund Office to verify your eligibility. See IRS Form W-8BEN Instructions. 

IRS Form W-8BEN Instructions - Review these instructions for completing the IRS Form W-8BEN Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding. 

Personal Representative Form - Complete this form to designate a Personal Representative to obtain personal information on your behalf from both the Laborers' Pension and Welfare Funds. Once completed and returned to the Fund, your personal representative will be recorded and they will be able to obtain pension and claim information from the Funds. Please note that your personal representative will need your social security number or alternate identification number and your date of birth when calling for information. 

Power of Attorney Form - Complete this form to designated a Power of Attorney to handle your financial affairs and authorize some one else to endorse pension checks and complete other Fund forms on your behalf. Please call the Fund for assistance in completing this form. 

Rollover Election Form - Complete this form to change your choice of payment for the partial lump sum payment, prior to the receipt of your 6th pension check. Partial lump sum payments can be paid directly to the pensioner, minus automatic 20% federal withholding taxes, or rolled over into an IRA account. The payment can also be split up, with a portion of the payment rolled over into an IRA account and the remainder paid directly to the pensioner, minus automatic 20% federal withholding taxes. A Rollover Notice is attached to this form.

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