Logo: AFTRA Retirement Fund

Performer Address Change Form


PERFORMER INFORMATION

Instructions: Please provide the following identifying information for yourself. The information required for processing your address change are indicated in the instructions for each section of the form. If you do not have your AFTRA No. please leave this blank.
 

Full Name:

Social Security No. AFTRA Retirement Fund No.

MAILING ADDRESS AND CONTACT INFORMATION

Instructions: Note that information in this section is REQUIRED in order to consider your address change complete. You must include a check mark next to the address you wish the AFTRA Retirement Fund to use for correspondence and other business purposes.
 

The Retirement Fund will default to the primary address if both address fields are completed and you do not select a box.

A: My Primary Residence(By selecting this address, you choose to have benefits correspondence mailed only to your primary residence)

Address Line 1

Address Line 2

City

State/Province Zip Country

Area Code and Telephone Number: Select Primary No.

Email Address

Mobile Home Work

B: My Representative's Office(By selecting this address, you choose to have benefits correspondence mailed only to your designated representative)

Representative Name

Company Name  

Address Line 1

Address Line 2

City

State/Province Zip Country

Representative Phone No

Email Address

 


If you choose to have your representative receive benefits information on your behalf, and you've provided the contact information of the designated representative(s)/organization(s) you must also provide a completed Authorization Form, as required by applicable privacy regulations.

I instruct AFTRA Retirement Fund to send Retirement Benefits correspondence and/or provide information to the above listed representative. Note that the AFTRA Retirement Fund may share the information provided on this form with the SAG-AFTRA Union, so that both the AFTRA Retirement Fund and the SAG-AFTRA Union have your current address and representation information.

I certify that all the information provided on this form and in any attached documents is accurate and complete.