Common Forms

Instructions for PDF use: Forms;

You will need Adobe Reader to view and print the following forms.
Click on the "Get Adobe Reader" link button provided below to download free Adobe Reader to view and print forms.

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This page contains many Underlined Links. Left-Click once on underlined text to open a "Download Window" for commonly used printable forms. Adobe Acrobat Reader is needed to open, view, and print these documents for use.

In order to fill out the form(s) in their open view and to email to the provided address, you need to own the Adobe Acrobat Program or another application (i.e. Paper Port) to convert the Adobe Reader document into an editable form. Otherwise you need to save the form to your PC and/or print the blank form. It would then be necessary to fill in the form and mail to the address provided on the Home Page.


Health & Welfare Forms


Subrogation and Reimbursement Agreement
Print a Subrogation and Reimbursement Agreement Form to fill out and mail to the Fund Office.
Open Subrogation and Reimbursement Agreement

COBRA Election Form
Print a COBRA Election Form to fill out and mail to the Fund Office.
Open COBRA Election Form

Beneficiary Designation
This form is used to elect or change your beneficiary information.
Open Beneficiary Designation

Change of Address Form
This form is used to change your address information.
Open Change of Address


Family Update Form
Complete this form to update the Fund office of any changes regarding your dependents and their insurance coverage.
Open Family Update Form


Defined Contribution Forms

401(k) Enrollment Form/Instructions
This form is used to enroll in the 401(k) wage deferral plan.
401 (k) Enrollment Form/Instructions

Beneficiary Designation
This form is used to elect or change your beneficiary information.
Open Beneficiary Designation


Application For Benefits
This form is used to apply for your benefit and to select how you would like to receive your payment.
Open Application For Benefits

Loan Application/ACH Set-Up
The loan application form is used to apply for a loan from the plan.
The ACH Set-Up form is used to designate the account that you want your monthly loan payment deducted from.
Open Loan Application/ACH Set-Up

Salary Deferral Form
This form is used to stop or change your deferral contribution.
Open Salary Deferral Form

Special Tax Notice
This notice provides general tax information as it pertains to the taxation of your benefit distribution. Since tax laws change, you should always consult a tax expert to determine your exact tax liability.
Open Special Tax Notice

If you have any questions or you wish to request any literature, please call:
(952)854-0795. 

Or, write to us at
Wilson McShane Corporation
3001 Metro Drive, Suite 500
Bloomington, MN 55425

Or, E-Mail us at: ufcw789benefits@wilson-mcshane.com