To submit this form, you can email it to BenefitServices@carpenterfunds.com or fax it to (510) 633-0333. If you prefer, you can also mail it to Carpenter Funds Administrative Office, 265 Hegenberger Road, Suite 100, Oakland, California 94621-1480. Make sure to retain a copy for your records and confirm receipt if sent electronically.

All applicants should be aware of regional deadlines for submitting disability claims, typically within 12 months from the first day of disability. Ensure your application is submitted timely to avoid delays in benefits processing. Keep track of local regulations and updates regarding submission timelines.

The purpose of this form is to facilitate the application process for temporary disability benefits for eligible participants. It outlines the requirements, necessary documentation, and instructions needed to assist applicants in detailing their claims accurately. By completing this form, members can receive financial support during periods when they are unable to work due to disability.

• 1. Applicant Name: The full name of the individual applying for benefits.
• 2. UBC Number: Unique identifier for the applicant related to the funds.
• 3. Residential Address: Current address of the applicant.
• 4. Email Address: Optional electronic contact for correspondence.
• 5. Phone Number: Contact number for the applicant.
• 6. Claim Date: Date when the claim for disability began.
• 7. Final Work Date: Last day the applicant worked before the claim.
• 8. Payment Proof: Documentation proving payments received from the insurance provider.

Failing to submit this form can result in delays in receiving your benefits. It is critical to ensure your application is sent in on time and contains all required information and documentation. Incomplete submissions may lead to further requests from the benefits office, prolonging the wait for assistance.

• Delayed Benefits: If the form is not submitted on time, you may experience a delay in receiving financial support.
• Ineligibility for Benefits: Missing documentation could lead to a determination of ineligibility for the benefits.
• Increased Stress: Delays may result in financial stress due to prolonged waiting periods.

• 1. Temporary Disability Claims: To apply for temporary financial assistance during periods of disability.
• 2. Health Coverage Maintenance: To ensure continuous health coverage while unable to work.
• 3. Pension Credit Inquiries: To inquire about pension credits available due to disability absence.