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Application for GROUP SHORT TERM DISABILITY INCOME INSURANCE for Members of the National Postal Mail Handlers Union (NPMHU) Issued through the Voluntary Benefits Plan Insurance Trust Complete this form and return to: UNION MEMBER BENEFITS 2025

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The document is an application form for Group Short Term Disability Income Insurance specifically designed for members of the National Postal Mail Handlers Union (NPMHU). It outlines the necessary member information, insurance request details, and a health statement that applicants must complete to apply for coverage under New York Life Insurance Company. The form includes sections for personal data, occupational status, requested insurance coverage, and health-related questions to assess eligibility.

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