Local Unions Supplemental Pension and Severance Fund Trust (LUSP) Forms

Complete the form in it’s entirety, then fax, email, or return to the address below.

Mail all Forms to:
365 Route 304 suite 204
Bardonia, NY 10954

Email address: general@lusptrust.org, attention Michellel.

Fax number: 845-501-4153
Telephone number: 845-367-7624

LUSP Trust Forms:

Enrollment Form – CWA Member Enrollment Form

Distribution Form – Request For Account Distributions

Correspondence Form – Indicates a change of name, address or beneficiary

Correspondence Form #2 – Additional Beneficiaries

Transfer – Death Benefit Form – Request for Transfer/Bennefit Payment

Annuity Benefit Election Form – Elect to receive a Nationwide Annuity

Forms will open in a separate window.