WELFARE

Change of Address Form

To update your address information, fill out this form and return it to the Fund Office.
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Change of Name Form

To update your name information, fill out this form and return it to the Fund Office.
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If you have a life-changing event and need to update dependent information, this form must be completed and sent to the Fund Office, with the appropriate documentation (birth certificate, marriage certificate, divorce decree, etc.). Make sure to include all dependents on the form or it will not be accepted.
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Family Privacy Form

If you want the Plan to disclose your protected health information to another individual(s), persons, class of persons, or organization of your choice (for example, your spouse), you must fill out this form and return it to the Fund Office. If your spouse and/or Dependent child(ren) over the age of 17 (i.e. Dependent child(ren) who are at least 18 years old) want the Plan to disclose their protected health information to you or anyone else, they also must fill out this form and return it to the Fund office.
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Dependent Child Enrollment Form

To enroll your dependent child for coverage under the Plan, submit a completed Dependent Child Enrollment Form or Information Verification Form along with a copy of the birth certificate or adoption papers to the Fund Office. If you are not married to your child’s birth mother/father, then you would also need to complete a Dependent Affidavit Form, have it notarized, and submit it to the Fund Office with any supporting documents. You must submit the completed enrollment form with the appropriate documentation to the Fund Office within 60 days of the event. If you do not enroll your dependent in 60 days, claims will be denied until you submit the required information.

Your birth child is eligible for coverage on the date of his or her birth. If you adopt a child, have a child placed with you for legal guardianship, or acquire a stepchild through marriage, he or she will be eligible for coverage on the date of placement or marriage, as long as you are responsible for healthcare coverage and your child meets the Plan’s definition of a dependent child.
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Beneficiary Designation Form

To designate a beneficiary for your death benefit, you must fill out this form and return it to the Fund Office.
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Dependent Affidavit Form

If you are not married to your child’s birth mother/father, then you need to complete this form, have it notarized, and submit it to the Fund Office with any supporting documents.
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Direct Payment Election Form

If you are Retiring (or have Retired) and are receiving a monthly Pension check that is greater than your Welfare monthly premium amount, you may authorize Welfare to deduct this monthly premium from your Pension check or to be paid via monthly ACH withdrawal from you bank account by completing a Direct Payment Election Form.
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Initial Loss of Time Claim Form

If you become disabled and are unable to work, you and your physician must complete this form and submit it to the Fund Office in order to receive the weekly Loss of Time (short-term disability) benefits.
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Supplemental Loss of Time Form

Once approved for the weekly Loss of Time (short-term disability) benefit, to continue to receive the benefit, you will be responsible to complete this Form.
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CIL PENSION

Change of Address Form

To update your address information, fill out this form and return it to the Fund Office.
Download

Change of Name Form

To update your name information, fill out this form and return it to the Fund Office.
Download

Direct Deposit Form

To sign up for direct deposit complete a Direct Deposit Form and return it to the Fund Office.
Download

Tax Withholding Form

To change the amount of the taxes withheld from your pension payment, complete a Tax Withholding Forms and return it to the Fund Office.
Federal W-4P Tax Withholding Form - Download
Missouri State W-4P Tax Withholding Form - Download
Kansas State K-4 Tax Withholding Form - Download

Beneficiary Designation Form

To designate a beneficiary for your death benefit, you must fill out this form and return it to the Fund Office.
Download

GKCL PENSION

Change of Address Form

To update your address information, fill out this form and return it to the Fund Office.
Download

Change of Name Form

To update your name information, fill out this form and return it to the Fund Office.
Download

Direct Deposit Form

To sign up for direct deposit complete a Direct Deposit Form and return it to the Fund Office.
Download

Tax Withholding Form

To change the amount of the taxes withheld from your pension payment, complete a Tax Withholding Forms and return it to the Fund Office.
Federal W-4P Tax Withholding Form - Download
Missouri State W-4P Tax Withholding Form - Download
Kansas State K-4 Tax Withholding Form - Download

Beneficiary Designation Form

To designate a beneficiary for your death benefit, you must fill out this form and return it to the Fund Office.
Download

VACATION

Change of Address Form

To update your address information, fill out this form and return it to the Fund Office.
Download

Change of Name Form

To update your name information, fill out this form and return it to the Fund Office.
Download

Member Login

Site Notice:

CONSTRUCTION INDUSTRY LABORERS'
& GREATER KANSAS CITY LABORERS'

FRINGE BENEFIT FUNDS

FORMS

FORMS

WELFARE

Change of Address Form

Change of Name Form

Information Verification Form

Family Privacy Form

Dependent Child Enrollment Form

Beneficiary Designation Form

Dependent Affidavit Form

Direct Payment Election Form

Initial Loss of Time Claim Form

Supplemental Loss of Time Form

CIL PENSION

Change of Address Form

Change of Name Form

Direct Deposit Form

Tax Withholding Form

Beneficiary Designation Form

GKCL PENSION

Change of Address Form

Change of Name Form

Direct Deposit Form

Tax Withholding Form

Beneficiary Designation Form

SMART

Change of Address Form

Change of Name Form

Beneficiary Form

Direct Deposit Form

VACATION

Change of Address Form

Change of Name Form

Member Login

Site Notice:

CONSTRUCTION INDUSTRY LABORERS' & GREATER KANSAS CITY LABORERS'

FRINGE BENEFIT FUNDS

FORMS

FORMS

WELFARE

CIL PENSION

GKCL PENSION

SMART

VACATION

CONSTRUCTION INDUSTRY LABORERS'
& GREATER KANSAS CITY LABORERS'