Address 1199 Seiu PDF Details

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QuestionAnswer
Form NameAddress 1199 Seiu
Form Length1 pages
Fillable?Yes
Fillable fields1
Avg. time to fill out27 sec
Other names1199 union number, 1199seiu fax number, 1199 union phone number, 1199 phone number

Form Preview Example

1199SEIU Benefit Funds

330 West 42nd Street, New York, NY 10036-6977 • www.1199SEIUBenefits.org

Tel (646) 473-9200 • Outside NYC Area Codes: (800) 575-7771

Change of Address Form

Print Clearly in Blue or Black Ink

Full Name:

Member ID:

Old Address:

City:

 

 

 

 

 

State:

 

 

 

Zip Code:

 

Old Telephone: (

 

)

 

 

 

 

 

 

 

 

Old E-mail:

 

 

 

 

 

 

 

 

 

 

 

 

New Address:

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

State:

 

 

 

Zip Code:

 

New Telephone: (

 

)

 

 

 

 

 

 

 

 

New E-mail:

 

 

 

 

 

 

 

 

 

 

 

 

Member’s Signature X

 

 

 

 

 

 

Date:

 

Complete and mail to:

1199SEIU Benefit and Pension Funds

Member Eligibility Department

PO Box 1035

New York, NY 10108-1035

Note: You should also complete Change of Address Form #3575 at your local Post Office.

CAM01

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