CHANGE MY MAILING ADDRESS FOR: (Check all that apply)
  • JIB CORRESPONDENCE
  • LOCAL #3
  • MEDICAL DEPARTMENT
  • ANNUITY CHECK ONLY
  • PENSION CHECK ONLY
  • PENSION & ANNUITY CHECKS
  • EMPLOYEES SECURITY FUND
    (For members of the Fixture, Manufacturing, or Supply Divisions)
This change also applies to the Deferred Salary Plan. The Joint Industry Board will notify Prudential of this change of address. Please complete ALL sections.

Union Card No.
City Division?
Participant ID (?)
Date of Birth

OLD ADDRESS:
Address1
Address2
City
State
Zip
Country

NEW ADDRESS: [Cannot be a bank address]
Address1
Address2
City
State
Zip
 -
Country
Contact JIB if you need to change the banking address information.

Home Telephone #
check    YES if this is a new Home Telephone #
Cell Phone #
check    YES if this is a new Cell Phone #
I certify I am the member stated above and understand that it is a crime to impersonate another person by electronic means, including through use of a website.