Have you ever experienced the frustration of having a
claim denied because of incorrect or incomplete information on your Enrollment Form?
Although it may seem insignificant, your Enrollment Form is one of the most important documents used by the Fund Office in
providing benefits to you and your family. By keeping your Enrollment Form current, you should not have to endure any
unnecessary delay in the payment of your benefits.
When to complete an Enrollment Form
Complete your first form when you start working as a Cement Mason; be sure to include all eligible dependents. After that, each
time your family status changes, complete and submit an updated Enrollment Form. Changes in family status include marriage;
birth or adoption of a child; custody of a stepchild; and divorce. When you submit an updated Enrollment Form, you must complete
the entire form, as your new form replaces the old one.
Participant Information Section:
Please print your (the Cement Mason’s) social security number and
name--first, middle, and last. Enter your mailing address, including zip code. The next line will ask you for your telephone
number, E-mail address (if applicable) and Local Union. Last will be your date of birth, gender and and marital status.
Dependent Information Section:
Enter the names of your eligible dependents. If the last name is different
from yours, also enter the last name. Enter each dependent’s date of birth, social security number, and relationship to
Required documents must accompany the Enrollment Form when you add a
dependent. Note that we only require you to send the document at the time you add the dependent.
Beneficiary Information Section:
In the next section, you are asked to identify your beneficiary. Include the
beneficiary’s social security number, first, middle, and last name, their relationship to you (spouse, child, parent, or
friend) and their mailing address.
Participant Statement Section:
Sign and date the form.
To request an Enrollment Form you can contact the Fund Office, visit your
Local Union Office or receive the form online here.