Benevolent Fund - Local Union 488

Please have the attending phsicians statement completed before starting this form. It is required for application to the benevolent fund.

Benevolent Fund Application

Name(Required)

First Last

UA Card #(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City Province Postal Code

Nature of Disability(Required)

Date of Disability(Required)

Expected Return to Work Date(Required)

Are you receiving WCB benefits?(Required)

Are you in a retraining program?(Required)

Are you waiting for surgery?(Required)

Are you in the hospital now?(Required)

Are you applying for canada disability benefits?(Required)

Attending Physician's Statement(Required)

Max. file size: 50 MB.

This form may be found on page 2 of the Benevolent Fund Application PDF.