Downloadable and/or Printable Forms

The following forms should be printed, completed, and returned to:

Plumbing and Pipefitting Industry Trust Fund Office
505 S. Broadway, Ste. 117
Wichita, KS 67202-3922
(316) 264-2339
1-800-423-6517
Fax(316) 264-9245


These forms are in a PDF format and can be read with Adobe Acrobat Reader®. Don't have reader? Click Here

Vision Form

This form must be downloaded & printed. Then complete the sections indicated on the form completed, and send it to the above address along with:

  • an itemized statement of charges from the provider of the vision services (breaking down each charge for exam, lenses, frames, and contacts)
  • a copy of your lens prescription (if contacts or glasses were purchased)
  • Claim Forms must be received in the Fund Office within one year and 90 days from the date services were provided

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Disability Form

Download & print and have your physician complete page 2 before sending both pages to our office.
Claim Forms must be received in the Fund Office within one year and 90 days from the date services were provided.
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Health & Welfare Subscriber Update Sheet

This form is used for adding or deleting dependants.
If you get married, divorced, or have a child, this is the form that needs to be completed & mailed to the Fund Office. Supporting documentation must accompany this sheet (i.e. marriage license, divorce decree, etc.).
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Death Benefit Beneficiary Form

The Plan provides $15,000 of Death Benefits and $15,000 of Accidental Death or Dismemberment Benefits. There is an additional benefit of $5,000 if you are killed in an automobile accident while wearing a seat belt. Dependents are not covered.
It is very important that the Fund Office have an up to date “Beneficiary Form” on file. If you die, your beneficiary should contact the Fund Office at 316-264-2339
(or 800-423-6517 if you do not live in the Wichita area) and forward a certified copy of the Certificate of Death to us.

(not available for download - you must call or email us and have one sent to you)


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