Forms

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ON-LINE FORMS

These forms cannot be completed electronically at this time. To use a form, print it, complete it, and either fax it to the Fund Office at the fax number on the form (if available) or mail it in.

Health & Welfare Forms

Pension Forms

• Application for Eligibility Extension 
  due to Disability

• Appointment of Personal  Representative

• Authorization Form

• Change of Address Form

• COBRA Qualifying Event Notification

• Dental Claim Form

• Designation of Beneficiary Form

• Enrollment Form

• Group Insurance Questionnaire

• Medical Claim Form

• Nevada Weekly Disability Application

• NMHC (Prescription) Mail Form

• Pain Management Pre-Authorization

• Prescription Drug Claim Form

• Retiree Open Enrollment Form

• Retiree Family Enrollment Form

• Sample Medical Child Support Order

• Student Verification Form

• Vision Enrollment Form

• Widow Open Enrollment Form

• Authorization to Deduct Health & Welfare Fee from Pension Check

• Change of Address Form

• Designation of Beneficiary Form

• Direct Deposit Request Form

• Health & Welfare Fee Self-payment Form

• Husband-and-Wife Option Election/Rejection Form

• Level Income (Social Security) Option
  Election Form

• Pension Application Form

• Pension Federal Tax Withholding Form

• Pension State Tax Withholding Form

• Sample Qualified Domestic Relations Order

Vacation - Holiday Forms

• Change of Address Form

• Designation of Beneficiary Form

• Request for Withdrawal Form

• Request for Withdrawal Form
  Southern Nevada

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http://www.adobe.com/products/acrobat/readstep.html