* 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.*
| 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) |