Forms

Complete & Print Forms - You can complete most of the forms listed below right on your computer before you print. Simply click on a field in the form and type in the appropriate information. Then print the completed form, sign and mail it to the Trust Office. These printable forms are in PDF format. To read and print them, you need the free Adobe Reader (which is probably already installed in your system). Click here if you do not have Adobe Reader installed on your system.

Enrollment

  • Enrollment Form (Western and Central Washington Benefit Package) — Your fringe benefit package includes a health and security plan, life insurance benefits, two pension plans, and a vacation plan. Before you and your eligible dependents can participate in these plans, you must complete this form in its entirety and return it to the Trust Office.

    If you are adding a Domestic Partner, please write or type "Domestic Partner" under the Relationship heading. If you are enrolling a dependent child of your Domestic Partner, please write or type "Partner, Dependent" under the Relationship heading.

  • Enrollment Form (Eastern Washington, Idaho, Montana, Wyoming Benefit Package) — If you were previously covered under the Carpenters-Employers Health and Security Plan of Washington-Idaho, you must have an updated Enrollment Form on file at the Trust Office for your claims to be paid.
  • Enrollment Form - Surviving Spouse — If you are the surviving spouse of a deceased participant, use this form to enroll for continuing health coverage under the Plan.
  • Change of Address — This is the Change of Address notice. Please fill out this form and submit it to the Trust Office if your address has changed.
  • Authorization To Transfer Fringe Benefit Contributions — Participants in the Trust may use this form to authorize the transfer of fringe benefit contributions.
  • Authorization To Transfer Fringe Benefit Contributions - Health and Security Contributions Only — Participants in the Trust may use this form to authorize the transfer of Health and Security fringe benefit contributions.
  • Authorization To Transfer Fringe Benefit Contributions - Pension Contributions Only — Participants in the Trust may use this form to authorize the transfer of Pension fringe benefit contributions.
  • Adult Child Insurance Questionnaire — As part of the Patient Protection and Affordable Care Act, most children are eligible under the Carpenters Health and Security Plan of Western Washington through age 25.
  • Child Enrollee Questionnaire — This Child Enrollee Questionnaire is used to establish basic facts about the child being enrolled in the plan.
  • Student Questionnaire — Please answer the questions on this form and provide proof of full-time student status for applicable quarters. This will be used to determine the student's eligibility under the plan.
  • Summer Student Questionnaire — Please answer the questions on this form and provide proof of full-time student status for applicable quarters.
  • Affidavit of Domestic Partnership — Complete this form and have it notarized. Be sure to send the documentation of joint financial responsibility requested on the Affidavit.
  • Domestic Partner Coverage - Affidavit of Dependent Status — Read the Explanation of Tax Issues Associated with Coverage for Domestic Partner. If you are seeking to establish that your Domestic Partner is a dependent for federal tax purposes, then complete the Affidavit of Dependent Status and have it notarized.

    If you are not seeking to establish dependency for tax purposes, you do not need to complete the form. The Trust will automatically assume that the value of health insurance for your Domestic Partner is taxable income, in accordance with IRS regulations. The Trust Office will send you an invoice for your first withholding payment and monthly remittance notices thereafter.

Self Contribution Coverage

COBRA

Retiree Health Plan

Claims