Logo: AFTRA Retirement Fund

  Performer Address Change Form


To complete the Address Change form, you MUST include your name AND social security number in the spaces below as it appears in our records.

Full Name:

Social Security No. AFTRA Retirement Fund No.

General Correspondence Address

Primary Residence

Representative's Office

Address Line 1:

Address Line 2:

ATTN:

City:

  State: ZIP Code:

Area Code and Telephone No.  

Email Address (required):  
  
If you checked Representative’s Office (e.g., agent, business manager, attorney, etc.) then enter:

Representative Name:
Representative's Company Name (if applicable):
  
Unless you request otherwise, all correspondence will be sent to the address you indicated above. If you want correspondence regarding retirement benefits to go to a different address, please complete the section directly below.

Alternate Correspondence Address (if different from General Correspondence Address)

  I instruct the AFTRA Retirement Fund to send Retirement Benefits correspondence to the address below:

Primary Residence

Representative's Office

Address Line 1:

Address Line 2:

ATTN:

City:

  State: ZIP Code:

Area Code and Telephone No.  

Email Address:  

If you checked Representative’s Office (
e.g., agent, business manager, attorney, etc.) then enter:

Representative Name:
Representative's Company Name (if applicable):
  
Performer's Signature (type in full name):
Date:
This form is a confidential legal document. The AFTRA Retirement Fund is committed to maintaining and protecting the privacy of the personal information you provide as required by Federal law. Please sign and send this completed form to the AFTRA Retirement Fund via email by clicking HERE, by fax (212) 499-4973, or by mail to the following address:
 

AFTRA Retirement Fund
Attention: Contribution Services
261 Madison Avenue, 8th Floor
New York, NY 10016-2312
Phone: (800) 562-4690


AFTRA Retirement Fund is a separate organization from SAG-AFTRA. You must submit a separate address change document to the union.
ADDCHG.02 Rev.01-17