Get Local 506

Completing the Local 506 form is a straightforward process that requires attention to detail to ensure accurate information submission. This guide will walk you through each section of the Replacement Drug Card Application, making it easier for you to fill out the form online.

Follow the steps to complete your application efficiently.

1. Press the ‘Get Form’ button to access the Replacement Drug Card Application and open it in your preferred editor.
2. In the Member Information section, please print your details clearly. Start by entering your full name, address, and contact information including telephone and cell numbers. Ensure to indicate your gender and marital status by choosing either ‘Married/Common-Law’ or ‘Single.’
3. Fill out the Replacement Benefit Card section. Indicate the reason for the replacement card request by checking the relevant box: Lost, Stolen, Damaged, Never Received, or Other. Provide your date of birth in the specified format and choose your specific plan type.
4. In the Member Disclosure Authorization section, print your name and provide your signature along with the date to confirm that the prescription drug benefit card is intended solely for your use or your approved dependents.
5. If applicable, include information for your spouse by providing their name and date of birth. Ensure all entries are typed or printed neatly to avoid processing delays.
6. After completing the form, review all entries for accuracy. Once satisfied, save the changes you made. You can then choose to download the completed form, print it, or share it via email.

Complete your Local 506 application online today to ensure a smooth process!