201-569-8801 ufcwfundsupport@ufcwnationalfund.org
UFCW National Health & Welfare Fund
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Complete and return

Forms

Following is a list of available forms in PDF format. Completed forms should be scanned and emailed only.

Beneficiary Designation Form

Change of Address Form (English)

Change of Address Form (Spanish)

Coordination of Benefits Form

Enrollment Form (English)

Enrollment Form (Spanish)

Short Term Disability (Loss of Time)

Short Term Disability (Loss of Time) New Jersey Residents

Vision Services Claim Form

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New Jersey Office

66 Grand Avenue
Englewood, NJ 07631
Phone: 201.569.8801
Fax: 201.569.1085 or NJFax@UFCWNationalFund.org

California Office

1212 W. Robinhood Drive, #3E
Stockton, CA 95207
Phone: 209.952.6533
Fax: 209.952.7325 or CAFax@UFCWNationalFund.org

Email Us

UFCWFundsupport@ufcwnationalfund.org

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i-Remit Employer Portal

Coming Soon!

Keep an eye out for our new Employer Portal where you will be able to easily remit to the Fund online. Stay tuned!

My Account Participant Portal

Coming Soon!

Keep an eye out for our new Participant Portal where you will be able to access more personalized information about your benefits. Stay tuned!