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CALIFORNIA STATE ASSOCIATION OF LETTER CARRIERS Disability Plan If you don't have Adobe Acrobat Reader click here INSTRUCTION DIRECTIONS NOTE: Return all forms to Benefits Unlimited, Inc. in the enclosed postage-paid envelope. I. I. Application Form (click to download) A. Complete Page 1 of the application. Complete Page 2 - of the application. B. Sign by the Signature of Primary Insured Line, and list your city and date of signature on the line above it.
II. Direct Deposit Form (click to download) A Fill in Part I - Lines 1 through 4b. B. Fill in Line 5b - Establish an Allotment -- Place the ($) amount of the cost of your disability amount in this space. C. Sign by the X" on Line 6a. D Fill in your Social Security number on Line 7c -- Follow the BUI with your Social Security number. No dashes or spaces are necessary. E. Provide us your Postal Ease Number and Employee ID number.
III. Return the Election Form (click to download)
IV. Mail all three completed forms to: Benefits Unlimited, Inc.
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