Change Of Address Form For Non Retired Participants
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T H E
W E S T E R N
C O N F E R E N C E
O F
T E A M S T E R S
P E N S I O N
T R U S T
CHANGE OF ADDRESS FORM FOR NON-RETIRED PARTICIPANTS
You may notify your Area Administrative Office of address changes by phone or by mailing in this signed form.
Don’t forget to SIGN the form before you mail it to the address shown below. Also remember to leave a forwarding
address with your local post office.
Please Print:
Participant’s Name ___________________________________________________________________________________
-
-
Participant’s Social Security Number ________________________________________________________________
New Mailing Address ________________________________________________________________________________
Street Address
_________________________________________________________________________________________________________
City
State
Zip Code
Signature _____________________________________________ Date ________________________________________
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Phone Number ( ________ ) ___________________________________________
Area Code
Important Note: Changes will only be made if this form is signed and dated by the Plan participant.
This form is for address changes only. Contact your Area Administrative Office with changes in
name or marital status. Beneficiary changes must be made on the Plan’s official Beneficiary Designation
Form for Non-Retired Participants. Contact your Area Administrative Office for a copy. Or print a
copy from the web site.
Questions? Call Toll-Free:
Northwest/
Northern California
Southwest Area
Keep your Plan records
Rocky Mountain Area
Area
Administrative Office
confidential. Once you
Administrative Office
Administrative Office
(866) 648-6878 or
fill out the form, fold
(800) 531-1489 or
(800) 845-4162 or
(626) 463-6100
and mail it in a sealed
(206) 329-4900
(650) 570-7300
envelope to:
Western Conference of
Teamsters Pension Plan
2323 Eastlake Avenue East
Seattle, WA 98102-3305
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