Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your employee or participant information. Fill in your social security number, last name, first name, and initial. Specify your local union and indicate your gender by selecting either male or female.
3. Provide your current address, including street address or P.O. box, city, state, and zip code. Ensure that your contact information is accurate by entering your home and cell phone numbers.
4. Complete the section for your birth date and marital status. If applicable, enter your date of marriage.
5. In the spouse information section, include your spouse's name, social security number or health insurance claim number, birth date, telephone number, and email address. If you do not have a spouse to enroll, proceed to the next section.
6. If you have dependent children to enroll, include their names, social security numbers or health insurance claim numbers, and birth dates. If there are no dependents to enroll, skip to the signature section.
7. Review the health benefits coverage provided by the NASI Welfare Fund and ensure all necessary documentation, such as marriage or birth certificates, is ready to submit if applicable.
8. Finally, sign and date the form at the bottom. This confirms that all information provided is accurate to the best of your knowledge.
9. Once completed, submit the form either by mailing it to the NASI Welfare Fund at the address listed or by faxing it to the provided number. You can also save changes, download, print, or share the completed form.

Complete your health coverage enrollment form online today.