ILWU-PMA Benefit Plans - View and Download Forms

All of the forms on our web site are in Adobe Acrobat format. If you do not have Adobe Acrobat Reader installed on your computer, please click the "Get Adobe Reader" image above-right to download the software. This software is free to install and use.

You can view and print a form by clicking on the name of the form on the list below.Once you have printed and completed the form you need, please sign the form and mail it to our office or to the address indicated on the form.

Personal Information Changes for Active Employees, Retirees and Survivors:

Change of Address for Active Employees
Change of Address for Retirees/Pensioners
Change in Marital Status
Change of Name

Dependent Changes for Active Employees, Retirees and Survivors:

Add Dependents (Active Employees and Retirees Only)
Delete Dependents (Active Employees, Retirees and Survivors)

Retirement Applications:

Normal Retirement Application
Disability Retirement Application

Pension Payment Changes:

Change of Address for Retirees and Survivors
Electronic Fund Transfer (Direct Deposit)
Federal Tax Withholding Election Form
CA State Tax Withholding Election Form

Health Benefits:

Coastwise Indemnity Plan Claim Form for Medical/Surgical Services
Diabetic Durable Equipment Claim Form
Hearing Aid Claim Form
Provider Nomination Form for Coastwise Indemnity Plan Members in California

Disability Supplement:

Supplemental Disability Claim for California