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Mail: P. O. Box 4100 Concord, CA 945244100 Telephone: (800) 5522400 Facsimile: (925) 7467549 www.ufcwtrust.comAPPOINTMENT OF PERSONAL REPRESENTATIVE FORM I.(Please Print)I. I.II. Information Regarding
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How to fill out ufcwtrust

01
To fill out the UFCWTrust form, follow these steps:
02
Start by downloading the form from the official UFCWTrust website or obtain it from your employer.
03
Carefully read through the instructions provided on the form to ensure you understand the requirements and necessary information.
04
Begin by providing your personal details such as your full name, address, and contact information.
05
Fill in your employment details, including your employer's name, job title, and start date.
06
Indicate your dependents by providing their names, ages, and relationship to you.
07
Fill in the requested details regarding your healthcare coverage, such as the type of plan you are enrolled in and any other relevant information.
08
If you have any additional information or special circumstances that need to be taken into account, ensure you include them in the appropriate sections.
09
Once you have completed filling out the form, review it to ensure all the information provided is accurate and complete.
10
Sign and date the form where indicated to certify the accuracy of the information provided.
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Submit the completed form as per the instructions provided, either by mailing it to the specified address or delivering it to the appropriate office.

Who needs ufcwtrust?

01
The UFCWTrust is designed for individuals who meet certain criteria and requirements. It is primarily intended for:
02
- Employees who are members of a participating UFCW (United Food and Commercial Workers) union.
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- Dependents of these employees who are eligible for healthcare coverage.
04
- Individuals who have met the necessary eligibility criteria for enrollment in the UFCWTrust healthcare plan.
05
Please note that specific eligibility requirements may vary, and it is best to refer to the official UFCWTrust guidelines or consult with your employer or union representative for accurate and up-to-date information on who is eligible for the UFCWTrust.
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UFCWTrust is a trust fund established by the United Food and Commercial Workers International Union.
Employers who have agreed to contribute to the trust fund are required to file UFCWTrust.
Employers must complete the required forms and provide the necessary information according to the guidelines provided by UFCWTrust.
The purpose of UFCWTrust is to provide benefits such as healthcare, pension, and other benefits to eligible union members.
Employers must report employee contributions, hours worked, and other relevant information related to employee benefits.
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