Below is a list of downloadable forms for our members’ convenience. Unless otherwise stated on the form, these forms must be mailed to:
Los Angeles Firemen’s Relief Association
P. O. Box 41903
Los Angeles, CA 90041
or faxed to (323) 259-5290 / DO NOT send any medical personal health information (PHI)
FAX Numbers
- Add/Drop Dependent (323) 259-5297
- Flu Vaccine Claim Form (559) 499-2464 or (323) 259-5295
- Green Form / Unprocessed Medical Expenses Claim Form (CA) (559) 499-2464 or (323) 259-5295
Relief Forms
- Designation Of Beneficiary: Download, Print and Mail
- Update Form: Download, Print and Mail
- Change Of Address Form: Download, Print and Mail or Email
- Application For Emergency Advancement
- Application For Financial Assistance
- Application For Trust Preparation Advancement
- Retired firefighter Sick or Injury Application
- Active firefighter Sick or Injury Application
- NIOD Statement
- Cemetery Plot Application
