Insulator & Asbestos Workers Local 14

International Association of Heat and Frost Insulators and Allied Workers Local 14

MORTUARY FUND DEATH BENEFITS

Members, please complete this form to provide the IAHFIAW LOCAL 14 with notification , in case of death, that the beneficiary named below is to receive your mortuary funeral benefits.
Member Name:
Reg#:
Email:
SS#:
Date of Birth:
Address:
City State Zip:
Beneficiary:
SS#:
Relationship:
Address:
City State Zip:

 Checking this box serves as my signature to authorize the beneficiary named above to receive my Mortuary Funeral Benefits.