Michigan Carpenters'

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Forms
Please Note:  In order to view and print the following forms, you must have the Adobe Acrobat Reader installed on your computer.  If you do not have the Adobe Acrobat Reader Software and wish to download it, you may do so by clicking on the image below.

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  • Retiree Dental Election Form

  • COBRA Election Form

  • Continuing Coverage Election Form

  • Retiree Election Form

  • Supplement to Medicare Election Form

  • Surviving Dependents' Election Form

  • Totally & Permanently Disabled Election Form

  • Widow Election Form

  • Flex Benefit Claim Form

  • Request for Extension of Coverage for Adult Children Under Age 26

  • Assignment of Benefits Form

  • Affidavit Declaring Marital Status

  • Direct Debit Authorization Agreement

  • Participant Data Card

  • Yearly Coordination of Benefits and Dependent Status Statement

  • COBRA Continuation Coverage - Election Form

  • Change of Address Form

  • Authorization and Request Form to Transfer Employer Contributions Under Reciprocity Agreements

  • Application for Member Death Benefit

  • Application for Spouse Death Benefit

  • Pension Deduction Authoriztion

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    6525 Centurion Drive, Lansing, MI 48917-9275
    Phone: 517.321.7502 • Toll-free: 800.273.5739 • Fax: 517.321.7508