Disability Application Forms

Disability Application Forms

While most forms used by the Fund Office are available for viewing and printing, please note that completion and submission of any of the application forms listed below DOES NOT mean that you have applied for benefits. Under current Plan provisions, certain steps must be taken, and time periods observed before the Trustees can act upon an application provisions.

You must contact the Fund office directly to apply for benefits. These forms should only be downloaded and used with Fund staff direction.

Click here to download the Disability Application Form.

• Disability Application Form

Click here to download the Physicians Report.

• Physician’s Report

In certain circumstances, your physician may also need to complete the following History of Medical Condition Report.

• History of Medical Condition Form

Depending on your age, your marital status, and the type of Disability Benefit you are applying for, the following forms may be required:

• Automatic Joint Survivor Waiver Form for Married Participants
• Declaration and Waiver Form for Unmarried or Separated Participants

To have your benefit payment directly deposited into your checking or savings account, please complete the following Direct Deposit Authorization Form.

• Direct Deposit Form

To have Federal Income Tax withheld from your monthly benefit, please complete the following Federal Income Tax Withholding Form.

• Federal Income Tax Withholding Form

To have Wisconsin Income Tax withheld from your monthly benefit, please complete the following Wisconsin Income Tax Withholding Form.

• Wisconsin Income Tax Withholding Form