The Relief

All Forms

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 ONLINE

Designation of BeneficiaryDownload & Email
Update FormDownload & Email
Change of AddressDownload & Email
Application for Emergency AdvancementDownload & Email
Application for Financial AssistanceDownload & Email
Application Trust Preparation AdvancementDownload & Email
Retired Firefighter Sick and Injury ApplicationDownload & Email
Active Firefighter Sick and Injury ApplicationDownload & Email
NIOD StatementDownload & Email
Cemetery Plot ApplicationDownload & Email

Medical Forms

Medical Plan Enrollment/Change FormDownload & Email
Flu Vaccine Claim FormDownload & Email
Disabled Dependent CertificationDownload & Email
Unprocessed Medical Expenses Claim Form (Green Form)Download & Email
Prescriptions: Express Scripts Home Delivery (Mail) Order FormDownload & Email