Motion Picture Industry Pension & Health Plans 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Participant's information, including last name, first name, middle name, date of birth, social security number or MPI ID, and contact details.
3. Next, provide your spouse's information in the designated fields: last name, first name, middle name, gender, and date of birth.
4. Carefully read and complete the declaration section. Ensure you check all applicable statements regarding your spouse's employment status and health insurance eligibility.
5. Sign and date the form at the bottom. Remember that an incomplete form will be returned.
6. Submit the completed form via email or fax as indicated. Alternatively, you can print it for mailing.

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