Benefits Online Forms

In order to save our members time, we are pleased to offer our most requested forms online. All forms should be filled out completely and mailed to the

     PBA Funds Office
     125 Broad Street
     11th Floor
     New York, NY 10004-2400

Note: Some of these forms may still have the PBA's address as 40 Fulton Street. Please do NOT return the forms to that address, but to the new one, 125 Broad Street, above.

pencilReimbursement for Real Estate Legal Services
pencilDental Claim
pencilHIPAA Authorization
pencilMedical Equipment Benefit
pencilDependent Life Insurance Enrollment
pencilLife Insurance Beneficiary Designation
pencilEnrollment
pencilAnnuity Plan Beneficiary Designation
pencilChange of Address
pencilCatastrophic Benefit Claim (Active members only)
pencilPension Fund
pencilHearing Aid
pencilOptical Benefit - Direct Reimbursement Claim Form