Mpi Change Address Form PDF Details

In the landscape of managing personal information for health and pension plans, the importance of timely updates to address details cannot be overstressed. The MPI Change of Address form serves as a critical tool for participants, retirees, survivors, spouses, and children affiliated with the Motion Picture Industry Pension and Health Plans, ensuring that their records are current. By offering a choice between updating a physical, mailing, or third-party address, the form accommodates a range of needs, acknowledging that circumstances vary widely among individuals. Notably, it includes provisions for those wishing to designate the release of their health and/or pension information to authorized third parties, under the condition of having appropriate legal documentation on file. The form also draws attention to the necessity of participant consent, emphasizing that a signature is imperative to validate the changes, thereby underlining the seriousness with which the information is handled. Furthermore, it clarifies that in addition to submitting this form, separate notifications must be shared with employers, local unions, and credit unions, underscoring the comprehensive approach required to ensure information is uniformly updated across all relevant entities. Lastly, the prompt towards embracing digital communication through the MPI "Go Green" initiative reflects an understanding of the evolving preferences and ecological considerations of its audience, rounding out the form's multifaceted purposes.

QuestionAnswer
Form NameMpi Change Address Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschange of address forms to send to publishers, mpi address, picture address form, motion picture health form

Form Preview Example

CH AN GE OF AD D RESS FORM

Return this Form to: MPI P.O. Box 1999

Studio City, CA 91614-0999

Toll Free: (855) 275-4674 Fax: (818) 766-1229

Email: service@mpiphp.org

PARTICIPANT ADDRESS CHANGE INFORMATION

Please Select One

Participant

Retiree/Survivor

Spouse

Child

Address Type

 

 

Physical

Mailing

Third Party* Type:

Name

MPID / SSN

Date of Birth

New Address

Effective Date(s)

City

State

Zip

Email

Phone

Fax

*If you would like personal health information to be sent to someone other than yourself, you need to complete an Authorization for Release of Health Information. If you are requesting the release of your Health and/or Pension information to a person with a Power of Attorney, Conservator or any third party, you must have the required legal documentation on file with MPI. Additional information and required forms for releasing your Health and Pension information may be found at www.mpiphp.org.

DEPENDENT/BENEFICIARY ADDRESS CHANGE INFORMATION (This form cannot be used to designate new beneficiaries)

Name

 

 

MPID / SSN

Date of Birth

 

 

 

 

 

New Address

Same as Participant’s Above

 

Effective Date(s)

 

 

 

 

 

City

 

 

State

Zip

 

 

 

 

 

Relationship

 

Email

 

Phone

 

 

 

 

 

 

 

 

 

 

Name

 

 

MPID / SSN

Date of Birth

 

 

 

 

New Address

Same as Participant’s Above

 

Effective Date(s)

 

 

 

 

 

City

 

 

State

Zip

 

 

 

 

 

Relationship

 

Email

 

Phone

 

 

 

 

 

 

 

 

 

 

Name

 

 

MPID / SSN

Date of Birth

 

 

 

 

New Address

Same as Participant’s Above

 

Effective Date(s)

 

 

 

 

 

City

 

 

State

Zip

 

 

 

 

 

Relationship

 

Email

 

Phone

 

 

 

 

 

PARTICIPANT’S CONSENT

I understand that the information I provided above will be used to update my records for both the Motion Picture Industry (MPI) Pension and Health Plans. I must provide separate notification to all Employers, Local Unions and Credit Unions. I further understand that I must submit this form to the address above each time this information changes to ensure I receive Plan information. My signature is required to validate the information on

this form.

Participant’s Signature

Date

If you would like to receive MPI Publications via email, please log-in to your MPI account at www.mpiphp.org and complete the “Go Green” process.

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mpi change address online writing process described (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - City, Relationship, Name, Email, New Address, Same as Participants Above, City, Relationship, Name, Email, New Address, Same as Participants Above, City, Relationship, and PARTICIPANTS CONSENT with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage # 2 of filling out mpi change address online

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