Dga Change Form PDF Details

Maintaining accurate records with financial and health institutions is crucial for receiving timely and relevant correspondence. The Change of Address Form provided by the DGA–Producer Pension & Health Plans is specifically designed to facilitate this process for participants looking to update their address details. Located at 5055 Wilshire Blvd, Ste. 600, Los Angeles, CA 90036, participants can send the completed form via mail, or alternatively, fax it to (323) 653-3560 for prompt processing. This service underscores the organization's commitment to ensuring that essential communications regarding pension and health plans reach the intended recipients without delay. In addition to basic participant information, the form allows for tailored mail preferences, enabling participants to direct where different types of mail should be sent, whether to a primary residence or a different address chosen by the participant. With options for pension-only or health-only correspondence, or a combination of both to a single address, it serves as a versatile tool for managing how plan members receive vital information. Additionally, the provision for special instructions caters to unique situations or additional address details. A requisite signature at the end of the form solidifies the participant's request, ensuring that their preferences are formally recorded and respected. It's important to note that the DGA-Producer Pension & Health Plans operates independently from the Directors Guild of America (DGA), implying that any address changes need to be communicated separately to the DGA to ensure comprehensive record updating across both organizations.

QuestionAnswer
Form NameDga Change Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdga change of residence, change of address forms printable, vsp form to change doctors mailing address, dga change

Form Preview Example

CHANGE OF ADDRESS FORM

Complete this form to change your address with our office. Return this form to us by mail to

Address Change Dept, DGA–Producer Pension & Health Plans, 5055 Wilshire Blvd, Ste. 600,

Los Angeles, CA 90036 or fax it to (323) 653-3560. If you have any questions, you can call (877) 866-2200 and ask for our Address Change Department.

1) Participant Information

PARTICIPANT NAME (Please print)

S.S.#

or

BIRTHDATE

2) Mail Preferences & Address Information

You may choose to receive all your mail at one address or you may have Pension mail sent to one and Health sent to the other. Check the appropriate box to indicate where you want your mail sent. (Only one address can be selected for each type of mail.)

ALL = Send both Pension & Health Mail to this address.

P = end only Pension mail to this address. Examples of Pension correspondence include: Summary Plan Description Booklet, Annual and Quarterly Statements, Retirement Benefits, and 1099s.

H = end only Health mail to this address.

Examples of Health correspondence include: Summary Plan Description Booklet,

 

Open Enrollment Information, Health Plan Coverage Cards, Premium Billing, and Claims.

 

 

PRIMARY RESIDENCE

Mail Preference: ALL P H

ADDRESS LINE 1:

LINE 2:

LINE 3:

HOME PHONE:

CELL

PHONE:

FAX:

LINE 4:

E-MAIL:

OTHER ADDRESS*

Mail Preference: ALL P H

INDICATE ADDRESS TYPE:

(Ex.: Business Mgr., Accountant, Attorney, Personal Business, 2nd Residence, etc.)

FIRM

NAME:

ADDRESS LINE 1:

LINE 2:

LINE 3:

LINE 4:

CONTACT:

PHONE:

ADD’L.

PHONE:

FAX:

E-MAIL:

*For security reasons, if you want the Plans to provide confidential information to a Third Party, please complete a Third Party Authorization Form.

3) Special Instructions

Use this space for an additional mailing address or for special mailing instructions.

4) Signature

PARTICIPANT’S SIGNATURE

(Required)

DATE

REMINDER: The DGA-Producer Pension & Health Plans is a separate entity from the Directors Guild of America (DGA). You must notify the DGA separately of your address change. Their address is 7920 Sunset Blvd., Los Angeles, CA 90046; phone (310) 289-2000 / (800) 421-4173.

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