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The following forms may be printed from your personal computer and sent to the Plan Office via a postal service. All forms are valid only when both the Social Security number and signature of the Participant are provided.

Please submit all completed forms for processing to:
Pension Department--Confidential
MPI Health Plan
P.O. 1999
Studio City, CA 91614-0999

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Select from the following category to reduce your search and scroll down to locate the form you are looking for.

Actives Only Forms
Retirees Only Forms
Actives and Retirees Forms

Pension Beneficiary Designation - You must complete a Pension Beneficiary card to designate the beneficiary(ies) of your Pension benefits. This is for pre-retirement death benefits only.
Pension Benefit Estimate - A benefit estimate can be a useful tool for deciding when to retire. The estimate will provide monthly MPI Pension Plan dollar amounts available to you at retirement over a range of ages and options, as well as provide you with your MPI Individual Account Plan balance as of the end of the previous year.


Direct Deposit Form - Complete this form to have your monthly pension benefits deposited directly into your checking or savings account. Your payment will be in your account by the 1st of each month with no hassles.
Federal Tax Withholding Form (W-4P) - Complete this Form W-4P if you would like to change the federal tax withholding from your monthly pension benefit. (We recommend you consult with your tax advisor before making any changes.)
State Tax Withholding Form (DE 4P) Form - Complete this Form DE 4P if you would like to change the state tax withholding from your monthly pension benefit (California residents only). (We recommend you consult with your tax advisor before making any changes.)
Retiree Re-Employment Notification Form - As a Retiree receiving a Pension benefit, you must notify MPI in writing within one week prior to your employment start date if you intend to work 40 or more Credited Hours in a Payroll Month. Please use the Retiree Re-Employment Notification Form when notifying MPI of your impending employment.
Payroll Months - For your convenience, we've calculated the current years worth of Payroll Months. Payroll Months, instead of calendar months, are used to calculate eligibility and pension benefits. A Payroll Month begins the Sunday before the last Thursday of a calendar month. It ends on the Saturday before the last Thursday of the subsequent calendar month.


Pension Authorization Form - In order to authorize the MPI Pension Plan to disclose your Pension and Individual Account Plans information, we require your authorization in writing. We strongly recommend you use our form so that all the necessary information is submitted with your request.
Change of Address - Please notify the Pension Department immediately when you have a change of address. This will ensure that you receive all benefits and related information from the Plan Office in a timely manner.
Request for Model/Sample QDRO - If a Participant divorces, any annuity, benefit or accumulated contributions from the Motion Picture Industry Pension and Individual Account Plans may be subject to claims by a former spouse under a Qualified Domestic Relations Order (QDRO). A QDRO is a court order issued under state domestic relations law which is required by ERISA in order for the Plans to distribute any portion of your benefits to a spouse, former spouse, child or other dependent for child support, alimony, or any other settlement of marital community property rights. A copy of the Plans’ QDRO procedures and a sample QDRO may be obtained without charge by clicking on this link or by contacting the Pension Department, 818 or 310.769.0007, Ext. 627. Outside Southern California, call toll-free 888.369.2007, Ext. 627.