Member Forms

Fund Wide Forms

New England
MA Beneficiary Designation (English Version)
MA Beneficiary Designation (Spanish Version)
CT Beneficiary Designation (English Version)
CT Beneficiary Designation (Spanish Version)
Member Address Verification Form (English & Spanish Version)
Electronic Disclosure Consent
MA Reciprocity Form (English & Spanish Version)
CT & RI Reciprocity Form (English & Spanish Version)

New York
NY Beneficiary Designation (English Version)
NY Beneficiary Designation (Spanish Version)
Change of Address Form (English & Spanish Version)
Electronic Disclosure Consent
NY Reciprocity Form (English & Spanish Version)

Pension Fund Forms

New England
Sample Pension Qualified Domestic Relations Order (QDRO)
Sample Pension Qualified Domestic Relations Order (QDRO)—Legacy CT Participants
W-4P Federal Withholding Tax Form (Periodic Payments)
W-4R Federal Withholding Tax Form (Non Periodic Payments)
W-8BEN Federal Foreign Withholding Tax Form
CT State Withholding Tax Form (Form CT-W4P)
MA State Withholding Tax Form (Form M-4P)
RI State Withholding Tax Form (Form RI W-4)

New York
Sample Qualified Domestic Relations Order (QDRO)- Separate Interest (Pre-Retirement)
Sample Qualified Domestic Relations Order (QDRO)- Shared Payment (Post-Retirement)
Sample Qualified Domestic Relations Order (QDRO)- Shared Payment (Pre-Retirement)
W-4P Periodic Payment Form
W-4R Non Periodic Payment Form
Tax Form Monthly (English & Spanish Version)
NASCPF Pension Application (Long Island)

Annuity Fund Forms

Guaranteed Annuity
Sample Guaranteed Annuity Fund Qualified Domestic Relations Order (QDRO)
W-4P Federal Withholding Tax Form (Periodic Payments)
W-4R Federal Withholding Tax Form (Non Periodic Payments)
W-8BEN Federal Foreign Withholding Tax Form
MA State Withholding Tax Form (Form M-4P)

Annuity – CT/RI Members
NASCAF Annuity Application
NASCAF Annuity Application – RI Pre 2018
W4-P Tax Form (CT)
NASCAF Hardship Application

Annuity – NY Members
NASCAF Profit Sharing Application
NASCAF Profit Sharing Application Instructions
NASCAF Hardship Application
NASCAF Hardship Application Instructions
NASCAF Money Purchase Application
NASCAF Money Purchase Application Instructions

Annuity – CT/RI/NY Members
W-4R Non Periodic Payment Form
W-4P Periodic Payment Form
NASCAF Annuity Monthly Installment Change
NASCAF Electronic Disclosure Consent Form
NASCAF Voluntary Contribution Form
NASCAF Hardship Loan Application
NASCAF Death Benefit Application

Health Fund Forms

New England
Dependent Health Enrollment Form (English & Spanish Version)
Personal Representative Form
Dependent Alternate Address Request
A&S Disability Claim Forms
Independence Administrators Subscriber Claim Form
Authorization for Release of Protected Health Information

New York Hours Based
Health Dependent Information Form (English & Spanish Version)
Health Coverage Attestation Form
Health Authorized Representative HIPAA Form (English & Spanish Version)
Health Adult Dependent Enrollment Form (English & Spanish)
Health Coordination Of Benefits Form (English & Spanish Version)

New York HRA
HRA Enrollment Form
HRA Authorized Reprensetative HIPAA Form
HRA Reimbursement Application

Vacation Fund Forms

New England
Window Dues from Vacation Disbursement Deduction Card

New York
Union Building Trades Credit Union_Membership Application
NY Credit Union Card (NY NAS Members Only)
NY Credit Union Card (Outside Members)

Collections Forms

New England
MA Reciprocity Form (English & Spanish Version)
NASCBF Reciprocal Request – Locals 326 (CT) & 330 (RI)
Cash-Con / ACH Authorization
CT & RI Reciprocity Form (English & Spanish Version)

New York
NY Shortage Form (English & Spanish Version)
NY Reciprocity Form (English & Spanish Version)