Local 1035 Member Forms

 

Please access the following links for Member Forms:

Accidental Dismemberment or Loss of Vision Claim Form

Affidavit Acknowledging Paternity

Affidavit of Financial Responsibility

Affidavit of Marital Status

Affidavit of Residence of Spouse

Affidavit of Spouse No Longer Living with Member

Annual Information Request Form (AirForm)

Anthem COB Workers Comp

Davis Vision Prior Approval

Group Life Insurance Conversion Form

Life Insurance Accidental Death Claim Form - English

Life Insurance Accidental Death Claim Form - Spanish

Life Beneficiary Designation

Life Waiver of Premium or Continuation of Benefits

Living Benefit Claim Form

Massage Therapy Reimbursement

Prescription Reimbursement

Suboxone Prior Authorization

Weekly Accident/Illness - Not Work Related

Weekly Accident/Illness - Work Related