Forms

* All forms can be returned via USPS to 5100 Ed Smith Way, Suite A Marion, IL 62959, via fax at (618) 997-9063 or via email at enrollment@silehw.org.*

IMPORTANT: Please read the information provided regarding the reporting of hours and wages. The Building Wage Addendum and the Heavy Hwy Wage Addendum can be found under Health and Welfare Forms below. You can find the 2023 Reporting Memo here, 2023 Reporting Memo.

Health and Welfare Forms

Health and Welfare
Title Download Info
2019 Claim Form Download Form 2019 Claim Form for Health Care Benefits
2020 Claim Form Download Form 2020 Claim Form for Health Care Benefits
2021 Claim Form Download Form 2021 Claim Form for Health Care Benefits
2022 Claim Form Download Form 2022 Claim Form for Health Care Benefits
2023 Claim Form Download Form 2023 Claim Form for Health Care Benefits
2024 Claim Form Download Form 2024 Claim Form for Health Care Benefits
Accident Claim Form Download Form All questions must be answered. Unanswered questions may delay benefit consideration!
Adult Child (Age 19-26) Enrollment Form Download Form This form must be completed in full for each adult child and submitted to the Fund Office within 30 days.
Change of Address Download Form Please notify the fund office immediately for change of address.
Construction Contribution Form Download Form Construction Contribution Form
Enrollment Card Download Form WE REQUIRE A MARRIAGE CERTIFICATE IF YOU HAVE A DEPENDENT SPOUSE & BIRTH CERTIFICATE FOR DEPENDENT CHILDREN
Masonry Agreement 2022-2025 Download Form Masonry Agreement 2022-2025
Medical Record Release Download Form Authorization for Release of Medical Information
Non-Contstruction (Industrial) Contribution Form Download Form Non-Contstruction (Industrial) Contribution Form
Ullico Beneficiary Form Download Form Ullico Enrollment and Beneficiary Form
Wage Addendum (Building Wage Rate) Download Form Local 773 & 1197 2023 Building Wage Addendum
Wage Addendum (Heavy Hwy Utility Wage Rate) Download Form Wage Addendum (Heavy Hwy Utility Wage Rate)
Wage Addendum (Oil and Chip Maintenance Work Wage Rate) Download Form Wage Addendum (Oil and Chip Maintenance Work Wage Rate)

Annuity Forms

Annuity
Title Download Info
Application for Benefits Download Form Application for Benefits for Annuity Fund
Beneficiary Card Download Form Annuity Beneficiary Card, Download and Print
Change of Address Download Form Please notify the fund office immediately for change of address.
Hardship Withdrawal Download Form Application for Hardship Withdrawal benefits.
Survivor's Benefit Download Form Application for Survivor's benefits
W-4R Download Form Withholding Certificate for Non-periodic Payments and Eligible Rollover Distributions

Vacation

Vacation
Title Download Info
Enrollment/Beneficiary Change Card Download Form Enrollment/Beneficiary Change Card for the Vacation Fund

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