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LOCAL 97 IRONWORKERS HEALTH & WELFARE PREVISED CARD CHECK HERE application FOR Enrollment AND BENEFICIARY DESIGNATION OFFICE USE ONLYPlease complete in ink and print clearly. This is a two sided form

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How to fill out enrolment card and beneficiary

01

Start by entering your personal information such as name, date of birth, address, and contact information on the enrolment card.

02

Provide details regarding any existing medical conditions or allergies that may be relevant for beneficiary purposes.

03

Specify the relationship between yourself and the beneficiary on the enrolment card.

04

Fill out the beneficiary section with their name, date of birth, contact information, and any necessary medical details.

05

Double-check all the information provided to ensure accuracy before submitting the enrolment card.

Who needs enrolment card and beneficiary?

01

Anyone who wishes to enroll in a program or service that requires beneficiary information would need to fill out an enrolment card and beneficiary.

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What is enrolment card and beneficiary?

An enrolment card is a document that signifies an individual's registration or enrollment in a specific program or service. A beneficiary is a person designated to receive benefits from a particular program, such as an insurance policy or government assistance.

Who is required to file enrolment card and beneficiary?

Individuals who wish to enroll in a program and receive corresponding benefits are required to file an enrolment card and designate a beneficiary.

How to fill out enrolment card and beneficiary?

To fill out an enrolment card and beneficiary form, individuals must provide personal information such as name, address, date of birth, and details of the beneficiary, including their relationship and contact information.

What is the purpose of enrolment card and beneficiary?

The purpose of an enrolment card is to officially register individuals in a program, while the beneficiary designation ensures that benefits are directed to the appropriate person in case of an event such as death or disability.

What information must be reported on enrolment card and beneficiary?

The enrolment card must report the individual's personal information, while the beneficiary form must include the beneficiary's name, relationship to the enrollee, and contact information.

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