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AirConditioning & Refrigeration Industry Joint Trust Funds 1380 S. Sanderson Ave. Suite 201 Anaheim, CA 92806 Telephone: 714 / 917-6100 Fax: 714 / 917-6065
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GENERAL FORMS MED01-Authorization Form BEN01-Beneficiary Designation Form COA1-Change of Address PEN02-Electronic Deposit Authorization W-4P - Form W-4P DE 4P-Witholding Cert. for Pension or Annuity Pymts Privacy Rights Notice DB02-Statement of Residency
PENSION / RETIREMENT FORMS Application: Retirement Benefits BEN01-Beneficiary Designation Form PEN02-Electronic Deposit Authorization DB02-Statement of Residency
DEFINED CONTRIBUTION FORMS DC01-Lump Sum Distribution / Direct Rollover Form DC02-Request Hardship Withdrawal 401K- Form 401(K) Payroll Deduction COA1-Change of Address
HEALTH & WELFARE FORMS Dental Benefits & Eligibility Fax Request Medical Benefits & Eligibility Fax Request W-9 -Request Tax Payer ID Express Scripts Order Form MED01 - Authorization Form DB01-Affidavit By Heirs at Law to Death Benefits DB05-Death Benefit Application BEN01- Beneficiary Designation Form COA1- Change of Address DIS01-Disibility Benefits Application Form Only DIS02-Doctor Order Continue Disability Notice of Privacy Practices
Please download and print form. E-mailed forms will NOT be accepted. Please mail all forms to the address below:
AirConditioning & Refrigeration Industry Joint Trust Funds 1380 South Sanderson Ave. Suite # 201 Anaheim, CA 92806
