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Forms

Formscpiadmin2023-01-16T09:57:11+00:00

General Forms

  • VAC01 – Electronic Deposit Authorization
  • VAC02 – Opt Out of Electronic Deposit
  • MED01 – Authorization Form
  • COA1 – Change of Address
  • PEN02 – Electronic Deposit Authorization
  • W-4P – Form W-4P
  • DE 4P – Withholding Cert. for Pension and Annuity Payments
  • DB02 – Statement of Residency
  • BEN01 – Beneficiary Form

Pension/Retirement Forms

  • Application: Retirement Benefits
  • Instructions for Application for Retirement Benefits
  • W-4P – Form W-4P
  • DE 4P – Withholding Cert. for Pension and Annuity Payments
  • BEN01 – Beneficiary Form
  • PEN02 – Electronic Deposit Authorization
  • DB04 – Death Benefit Application

Defined Contribution Forms

  • 401K – Form 401(K) Payroll Deduction
  • COA1 – Change of Address
  • Lump-Sum Distribution Form
  • Hardship Withdrawal Form
  • Beneficiary Distribution Form
  • QDRO Distribution Form
  • Special Tax Notice

Health & Welfare Forms

  • MED01 – Authorization Form
  • DB01 – Affidavit by Heirs at Law to Death Benefits
  • DB05 – Death Benefit Application
  • COA1 – Change of Address
  • DIS01 – Disability Benefits Application Form Only
  • DIS02 – Doctor Order Continue Disability
  • Medical/Dental Plan Change Request
Please download and print form. Emailed forms will NOT be accepted. Please mail all forms to the address below:
Air Conditioning & Refrigeration Industry Joint Trust Funds
3500 W. Orangewood Ave.
Orange, CA 92868;

AirConditioning & Refrigeration Industry Joint Trust Funds

3500 W. Orangewood Ave. Orange, CA 92868

Phone: 714 / 917-6100

Fax: 714 / 917-6065

© Copyright 2015 Air Conditioning & Refrigeration Industry Joint Trust Funds