Application For Plan Membership

UNITE HERE HEALTH & WELFARE PLAN

Enrollment and Beneficiary Designation Form

Application For Plan Membership Offline

 
Instructions :
In Step 1, the form need to be filled and downloaded.
Here Step 2, the scanned copy of the filled in form need to be uploaded.

Required upload size: 0.01MB - 10MB

 
Instructions for OTP :
A one-time password (OTP) is an secure token that is automatically generated by the system which is used to authenticate the user for a form submission.
Below Email will be validated with an OTP which will be sent to your Email address.
Please provide your email id and click on 'Click Here to send OTP' button BELOW to receive the OTP.
The OTP needs to entered in the designated box below 'Enter OTP here'