Forms

    * All forms can be returned via USPS to 5100 Ed Smith Way, Suite A Marion, IL 62959, via fax at (618) 997-9063 or via email at enrollment@silehw.org.*

    IMPORTANT: Please read the information provided regarding the reporting of hours and wages. The Building Wage Addendum and the Heavy Hwy Wage Addendum can be found under Health and Welfare Forms below. You can find the 2023 Reporting Memo here, 2023 Reporting Memo.

    Health and Welfare Forms

    Health and Welfare
    Title Download Info
    2019 Claim Form Download Form 2019 Claim Form for Health Care Benefits
    2020 Claim Form Download Form 2020 Claim Form for Health Care Benefits
    2021 Claim Form Download Form 2021 Claim Form for Health Care Benefits
    2022 Claim Form Download Form 2022 Claim Form for Health Care Benefits
    2023 Claim Form Download Form 2023 Claim Form for Health Care Benefits
    2024 Claim Form Download Form 2024 Claim Form for Health Care Benefits
    2025 Claim Form Download Form 2025 Claim Form for Health Care Benefits
    2026 Claim Form Download Form 2026 Claim Form for Health Care Benefits
    Accident Claim Form Download Form All questions must be answered. Unanswered questions may delay benefit consideration!
    Adult Child (Age 19-26) Enrollment Form Download Form This form must be completed in full for each adult child and submitted to the Fund Office within 30 days.
    Building & Heavy Highway Agreement 2025 - 2030 Download Form HigBuilding & Heavy Highway Agreement 2025 - 2030
    Change of Address Download Form Please notify the fund office immediately for change of address.
    Construction Contribution Form Download Form Construction Contribution Form
    Enrollment Card Download Form WE REQUIRE A MARRIAGE CERTIFICATE IF YOU HAVE A DEPENDENT SPOUSE & BIRTH CERTIFICATE FOR DEPENDENT CHILDREN
    Masonry Agreement 2025 - 2030 Download Form Masonry Agreement 2025 - 2030
    Medical Record Release Download Form Authorization for Release of Medical Information
    Non-Contstruction (Industrial) Contribution Form Download Form Non-Contstruction (Industrial) Contribution Form
    Ullico Beneficiary Form Download Form Ullico Enrollment and Beneficiary Form
    Wage Addendum (Building Wage Rate Local 703) Download Form Local 703 Building Wage Addendum
    Wage Addendum (Building Wage Rate Local 773 & 1197) Download Form Local 773 & 1197 Building Wage Addendum
    Wage Addendum (Heavy Hwy Utility Wage Rate Local 159 & 703) Download Form Local 159 & 703 Wage Addendum (Heavy Hwy Utility Wage Rate)
    Wage Addendum (Heavy Hwy Utility Wage Rate Local 773 & 1197) Download Form Local 773 & 1197 Wage Addendum (Heavy Hwy Utility Wage Rate)
    Wage Addendum (Oil and Chip Maintenance Work Wage Rate) Download Form Wage Addendum (Oil and Chip Maintenance Work Wage Rate)

    Annuity Forms

    Annuity
    Title Download Info
    Application for Benefits Download Form Application for Benefits for Annuity Fund
    Beneficiary Card Download Form Annuity Beneficiary Card, Download and Print
    Change of Address Download Form Please notify the fund office immediately for change of address.
    Hardship Withdrawal Download Form Application for Hardship Withdrawal benefits.
    Survivor's Benefit Download Form Application for Survivor's benefits
    W-4R Download Form Withholding Certificate for Non-periodic Payments and Eligible Rollover Distributions

    Vacation

    Vacation
    Title Download Info
    Enrollment/Beneficiary Change Card Download Form Enrollment/Beneficiary Change Card for the Vacation Fund

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