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Enrolment, Beneficiary Designation & Member Changes |
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Complete the Enrolment
Card and Beneficiary Designation to enrol in the
Millworkers Health & Welfare Plan (Unifor) and to enrol your
dependents and assign your beneficiary(s).
Once a Member is enrolled in the Plan, all changes to Member information,
dependents or beneficiaries should be made by completing this
form in full and submitting it to the Plan Administrator. |
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Information Needed to Complete the Form
Your personal Member information is needed to complete the form, including the dates of
birth for all eligible dependents, and the policy number of any other group insurance plans
that you or your dependents may also be covered under. Please follow the instructions on the
form and ensure that you have completed the card in full.
You may select a revocable beneficiary of your choice for your Life Insurance benefits.
With respect to your Pension benefits, if you have a spouse, you must designated him/her as
your Pension beneficiary. If you do not have a spouse, you may select any person, or your
estate, to be your Pension beneficiary. Please ensure that you complete this section of the
card.
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Notes
Questions on completing the form should be directed to the Plan Administrator.
Completed forms should be sent to the Plan Administrator. |
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Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
4250 Canada Way
Burnaby, BC, V5G 4W6
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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