Performer Address Change Form
PERFORMER INFORMATION
Instructions:
Please provide the following identifying information for yourself. The information required for processing your address change are indicated in the instructions for each section of the form. If you do not have your AFTRA No. please leave this blank.
Full Name:
(required)
Social Security No.:
(required)
AFTRA Retirement Fund No.:
(optional)
ADDRESS VERIFICATION
Instructions:
Skip this section if you are
not
responding to an Address Verification Mailing.
If you've received an
Address Verification Mailing
, please confirm your address below:
The address on the letter is correct
Yes
No
If you select NO, complete the mailing address and contact information section below.
MAILING ADDRESS AND CONTACT INFORMATION
Instructions:
Note that information in this section is REQUIRED in order to consider your address change complete.
You must include a check mark next to the address you wish the AFTRA Retirement Fund to use for correspondence and other business purposes.
The Retirement Fund will default to the primary address
if both address fields are completed and you do not select a box.
A:
My Primary Residence
(By selecting this address, you choose to have benefits correspondence mailed only to your primary residence)
Address Line 1
Address Line 2
City
State/Province
Zip
Country
Area Code and Telephone Number: Select Primary No.
Email Address
Mobile
Home
Work
B:
My Representative's Office
(By selecting this address, you choose to have benefits correspondence mailed only to your designated representative)
Representative Name
Company Name
Address Line 1
Address Line 2
City
State/Province
Zip
Country
Representative Phone No
Email Address
If you choose to have your representative receive benefits information on your behalf, and you've provided the contact information of the designated representative(s)/organization(s) you must also provide a completed Authorization Form, as required by applicable privacy regulations.
I instruct AFTRA Retirement Fund to send Retirement Benefits correspondence and/or provide information to the above listed representative.
Note that the AFTRA Retirement Fund may share the information provided on this form with the SAG-AFTRA Union, so that both the AFTRA Retirement Fund and the SAG-AFTRA Union have your current address and representation information.
I certify that all the information provided on this form and in any attached documents is accurate and complete.