Change of Address Form

It is very important that the Fund Office has, in addition to your mailing address, a record of your current physical address on file. Your physical address is important for Plan enrollment.

The Fund office will continue to send communications to the mailing address you specify, not the physical address, if they are different. Please complete the form below:

Participant Information

Social Security Number / OE ID

Date of Birth Please enter your birthday in the indicated format or click the calendar to pick your birthdate.

Last Name Last name is required and may contain letters, spaces and any of . ' -

First Name First name is required and and may contain only letters.

Middle Initial Middle initial may contain one letter.

Mailing Address/Contact Information

Street Address Street address is required and may contain letters, numbers, and any of . ' -,

City City is required and may contain letters, spaces, and any of . ' -

State

ZIP Code Zip code is required must contain exactly five digits.

Home Phone Number

Mobile Phone Number

Email Confirmation of submission of this form will be sent to this email address.

Is your physical address the same as your mailing address?

Yes

No

Physical Address

Street Address Street address may contain letters, numbers, spaces and any of . , ' -

City City is required and may contain letters, spaces, and any of . ' -

State

ZIP Code Zipcode must contain exactly five digits.

I understand that by checking this box I acknowledge that I am the signee and that entering my name in the Electronic Signature field constitutes a legal signature. Further, I warrant and agree that I am duly authorized to sign and that the information I entered on this form is correct to the best of my knowledge.

I hereby certify under penalty of perjury that the foregoing statements are true and complete to the best of my knowledge.

E-Signature

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Local 12

So. Cal. Training Trust

Southern Nevada Training Trust

I.U. OF OPERATING ENGINEERS