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Get CA Claim Form 2012-2024

PIPE TRADES PENSIONERS & SURVIVING SPOUSES HEALTH FUND (For Active Participants & Eligible Dependents) (i) A new claim form is required once every calendar year. (ii) A new claim form is required for each new injury. (iii) This Claim Form is necessary for the Fund to determine eligibility for benefits. All questions must be answered or Claim Form will be returned. This form will NOT be valid unless signed in Part V. Failure to complete and sign this form will delay the processing of your claim.

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