Michigan Carpenters' Fringe Benefit Funds

Health Care Information - Participant Forms

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Affidavit Declaring Marital Status

Application for Member Death Benefit

Application for Spouse Death Benefit

Assignment of Benefits Form

Authorization and Request Form to Transfer Employer Contributions Under Reciprocity Agreements

Beneficiary Designation Form

Change of Address Form

COBRA Election Form

Continuing Coverage Election Form

Direct Debit Authorization Agreement

Flex Benefit Claim Form

Medicare Information Form

Pension Deduction Authoriztion

Physical Exam Verification Form

Reciprocity Authorization for Transfer of Contributions

Request for Extension of Coverage for Adult Children Under Age 26

Retiree Election Form

Supplement to Medicare Election Form

Surviving Dependents' Election Form

Totally & Permanently Disabled Election Form

Widow Election Form

Yearly Coordination of Benefits and Dependent Status Statement