UFCW Local 5: Serving the interests of members in Alameda, Contra Costa, Monterey, Napa, San Benito, Santa Clara, Santa Cruz and Solano Counties and members in Agriculture throughout California and Arizona

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Forms

Form Title

Form Number
UFCW Employee Benefits Plan of Northern California Enrollment Form BAY-01-ENR
Legal Dependent Application For Benefits Legal Dep App
Application for Eligibility Extension Because of Disability (updated) E-1
Request for Reimbursement of Prescription Drug Co-Payments NC-25
Sick Leave/Disability Form ComboSickLeave
Pension Enrollment P-2
Instruction for Completing an Application for Retirement Benefits RC-10
Inquiry Regarding Pension Credits RC-21
UFCW Northern California and Drug Employers Health & Welfare Trust Fund Participant Data VC-27
Food Store Bidding FoodBid
Meat Division Bidding MeatBid
Request For Withdrawal Form RWD.pdf
   
Student Cert Bay Valley Updated StudCert