401(k) Plan

• Deferred Salary Plan Direct Deposit (PDF, 96K)
• Deferred Salary Plan Benefit Application (PDF, 76K)
• Deferred Salary Plan Medical and Dental Record (“Form A”) (PDF, 14K)
• Deferred Salary Plan Prescription and/or Over-the-Counter Drug Record (“Form B”) (PDF, 17K)
• Beneficiary Designation (PDF, 20K)
• Important Beneficiary Information (PDF, 70K)
• Landlord Affidavit (PDF, 8K)
• Coordination of Benefit Payments (PDF, 73K)
• Deferred Salary Plan Application For Wage Replacement Day and Picket Duty Benefits (PDF, 13K)
• Deferred Salary Plan Picket Duty Confirmation Form (PDF, 10K)
• Street Lighting Division - Wage Replacement/Inclement Weather Application For Benefits (PDF, 75K)

• Deferred Salary Plan SPD - NEW (PDF, 211)
• 401(k) Plan Priority Payment Benefit Chart (PDF, 11K)

Annuity Plan

• Annuity Plan Withholding/ Rollover Election Form (PDF, 68K)
• Annuity Direct Deposit Form (PDF, 36K)
• Change of Address (PDF, 29K)
• Designation of Beneficiary Form (PDF, 20K)
• Important Beneficiary Information (PDF, 70K)
• Annuity Direct Deposit Form (PDF, 36K)
• Beneficiary Designation (PDF, 20K)
• 2010 Tax Information (PDF, 55K)

• Annuity Plan SPD - NEW (PDF, 173K)

Dental Plan

• Empire BlueCross BlueShield Dental Claim Form (PDF, 93K)

• Dental Benefit Fund of the Electrical Industry SPD - (PDF, 289K)

Educational & Cultural Trust Fund

• OSHA Safety Class Registration (PDF, 19K)
• Educational & Cultural Class Offerings Registration (PDF, 122K)
• Educational & Cultural Program Information Request Form (PDF, 13K)
• Beneficiary Designation (PDF, 20K)
• Important Beneficiary Information (PDF, 70K)
• Stress Management Availability Information Form (PDF,41K)
• Scholarship Brochure Information (PDF, 2.16 MB)
• Registration Application for GED Preparation Classes (PDF, 73K)
• Conduit Bending Seminar Form (PDF, 38K)
• ESL Classes Registration Form (PDF, 19K)
• Return to College At Empire State (PDF, 765K)
• Camp Integrity 2013 Boys Application Package (PDF, 1.44 MB)
• Camp Integrity 2013 Girls Application Package (PDF, 1.43 MB)

• “The Treasure Chest” (Educational & Cultural Trust Fund booklet) (PDF 11.8M)
• Camp Integrity 2013 Brochure (PDF, 1.46 MB)

• ESF Health and Welfare Plan Enrollment Form (PDF, 90K)
• ESF Health and Welfare Plan Claims Form (PDF, 64K)
• ESF Pension Direct Deposit Form (PDF, 13K)
• ESF Pension Tax Change Form (PDF, 12K)
• ESF Health and Welfare Plan Optical Benefits Request Form (PDF, 75K)
• ESF Medco Mail Order Form (PDF, 61K)
• ESF Dental Claim Form (PDF, 64K)
• ESF - Change of Address Form (PDF, 16K)

• Employees’ Security Fund Health and Welfare Plan SPD (PDF, 395K)
• Employees’ Security Fund Prescription Drug Benefit Handbook (PDF, 476K)
• Employees’ Security Fund of the Electrical Products Industries Pension Plan SPD (PDF, 73K)
• ESF Medical Plan Certificate of Creditable Coverage (PDF, 35K)
• Important Changes to Your Health Plan Effective 1/1/2013 (PDF, 329K)
• Pension Credit Increased for Active Employees (PDF, 26K)
• New Joint and Survivor Pension Options Adopted (PDF, 30K)
• Medco Savings Opportunities Newsletter (PDF, 343K)
• Health Care Advocate Brochure (PDF, 863K)

N/A

• Legal Services Plan of the Electrical Industry SPD (PDF, 299K)

Pension Plan (the Pension Trust Fund for the Electrical Industry)

• PHBP Pension Tax Change Form (PDF, 12K)
• PHBP Pension Direct Deposit Authorization Form (PDF, 13K)

• Pension Hospitalization Benefit Plan (PHBP) Pension Trust Fund SPD (PDF, 305K)