.jpg)
Dependents
John Doe
Relationship:
Child
Birthday:
11/11/2000
SSN:
XXX-XX-XXX
Home Phone:
+1 234 567 8900
Cell Phone:
+1 234 567 8900
Email:
example@example.com
Address 1:
1 Example Street
Address 2:
Unit 1
City:
New York
State:
New York
Zip:
10000
To update or make changes to your dependents, you can either fill out this online New Enrollment Form. Or you can print and fill out this new enrollment form and send it back to us with your updated dependents. You can either scan and email it back to us or send it to the USWU offices at:
ATTN: Member Services
145 Huguenot Street, Suite 420
New Rochelle, NY 10801