D.A. Townley.  -  Plan Administrators      
 

health
benefits

        
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
 
   
 

Enrolment, Beneficiary Designation & Member Changes

Complete the Enrolment Card and Beneficiary Designation to enrol in the Millworkers Health & Welfare Plan (Unifor) and to enrol your dependents and assign your beneficiary(s).

Once a Member is enrolled in the Plan, all changes to Member information, dependents or beneficiaries should be made by completing this form in full and submitting it to the Plan Administrator.


Information Needed to Complete the Form
Your personal Member information is needed to complete the form, including the dates of birth for all eligible dependents, and the policy number of any other group insurance plans that you or your dependents may also be covered under. Please follow the instructions on the form and ensure that you have completed the card in full.

You may select a revocable beneficiary of your choice for your Life Insurance benefits. With respect to your Pension benefits, if you have a spouse, you must designated him/her as your Pension beneficiary. If you do not have a spouse, you may select any person, or your estate, to be your Pension beneficiary. Please ensure that you complete this section of the card.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be sent to the Plan Administrator.


Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
160 – 4400 Dominion Street
Burnaby, BC V5G 4G3

Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136

Email: Health
 

Form Link
Enrolment Card and Beneficiary Designation (English)
Enrolment Card and Beneficiary Designation (French)
 

Related Links
 
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