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Declination of Welfare Fund Benefits - All Benefits
Use this form to decline all Welfare Fund benefits for yourself and eligible dependents. You must sign this form and have it notarized.
Declination of Welfare Fund Benefits - For Eligible Dependents
Use this form to decline Welfare Fund benefits for your eligible dependents. You must sign this form and have it notarized.
Declination of Welfare Fund Benefits - Dental and/or Vision
Use this form to decline Welfare Fund dental and/or vision benefits for yourself and eligible dependents. You must sign this form and have it notarized.