Umwa Address PDF Details

Navigating the complexities of health and retirement benefits can be challenging, especially for mineworkers and their dependants. The UMWA Health and Retirement Funds Call Center has taken steps to streamline one of the most critical aspects of maintaining accurate records: the Change of Address Request. As of October 1, 2003, this procedure requires a written request to be completed, signed either by the miner, the widow, or their legal representative, and then mailed to the Call Center's Washington, DC office. This form is vital for ensuring that all communications and benefits are correctly directed to the recipient's current address. It asks for detailed information, including the full name of the mineworker or widow, their social security number, telephone number, both the old and new addresses, and a list of dependents living with them. Additionally, the form accommodates circumstances where a beneficiary cannot sign for themselves, requiring proof of legal authority such as power of attorney or guardianship to be provided. This change aims to protect the integrity of the process and the beneficiaries' information, making sure that the UMWA Health and Retirement Funds can continue to serve its members effectively.

Form NameUmwa Address
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesumwa health request, umwa change of address form, umwa funds request, umwa health request online

Form Preview Example


2121 K Street, Suite 350 Washington, DC 20037 Telephone: (800) 291-1425

Change of Address Request

Effective October 1, 2003, all address changes must be requested in writing and signed by the miner/widow or the legal representative. Please complete this form and return it to:

UMWA Health and Retirement Funds

Attn: Call Center

2121 K Street, NW Suite 350

Washington, DC 20037

Please print clearly and provide all information requested.

Mineworker/Widow Name: _______________________________________________________

(Last, First, Middle)

Social Security Number: _________-_______-___________

Telephone Number: (________)__________-____________

List All dependents currently living with you:_________________________________________


Current Address:

Street Address: _________________________________________________________________

City or Town, State and Zip Code: _________________________________________________

Old Address:

Street Address: _________________________________________________________________

City or Town, State and Zip Code: _________________________________________________

Signature: __________________________________________________Date: ______________

If signing for a beneficiary, you must include legal proof of your power of attorney or guardianship status or relationship.

If witnessing a beneficiary's mark, write out both the full name of the beneficiary for whom you are witnessing and your full name.

If the beneficiary is unable to make a mark, and has not granted you power of attorney or guardianship, please describe the circumstances on the back and provide your telephone number.

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