Employee Address Change Form - California Field Ironworkers Trust Funds
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1CALIFORNIA FIELD IRONWORKERS TRUST FUNDS
•
•
P ension Trust
W e lfa r e P lan
V a cation Trust
Appr en ticesh ip Train ing & Journeyman
•
Retrain ing Fund
Annu ity Trust
ADDRESS FORM
FOR NEW EMPLOYEE INFORMATION AND ALL ADDRESS CHANGES
THIS FORM MUST BE COMPLETED IN ITS ENTIRETY
SHOULD THIS FORM BE RECEIVED BY THE TRUST FUND OFFICE WITH INFORMATION MISSING OR
ILLEGIBLE, IT WILL BE RETURNED FOR RECOMPLETION AND/OR CORRECTION, WHICH WILL CAUSE A
THESE CHANGES.
DELAY IN THE PROCESSING OF
Name: _______________________________________________________________________
Gender:
M
F
(Last)
(First)
(MI)
SSN: _____________________________________
Local Union No: ____________ Date of Birth: _____________
Member Signature: _____________________________________________________ Date:
_______________
NEW ADDRESS INFORMATION
Completing this form will permanently change your address with the Trust Fund Office.
This change
will remain in effect until either a new Address Form is completed or returned mail is received by our
office, at which time your address will be made bad and no further items will be sent including
Vacation Checks.
Name:
_________________________________________________________________
Address:
_________________________________________________________________
City, State, Zip:
_________________________________________________________________
Telephone:
__________________________________________________________________
***IMPORTANT***
The Trust Fund Office WILL NOT accept these forms via fax or email. This form must
be returned to us either in person or via the U.S. Postal Service and an original
signature is required.
Also, please remember to notify your Local Union of ANY change of address, as we
will not be providing this information on your behalf.
IMPORTANT: UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974, TRUST FUNDS ARE REQUIRED TO KEEP ALL PARTICIPANTS ADVISED OF ALL BENEFITS TO
WHICH THEY ARE ENTITLED. IN ORDER FOR THE TRUSTS TO KEEP YOU PROPERLY INFORMED OF ALL YOUR RIGHTS, WE MUST OBTAIN CERTAIN INFORMATION REQUESTED
ON THIS FORM. FAILURE TO DO SO WILL RESULT IN A DELAY IN DELIVERY OF YOUR VACATION CHECK.
APPLICANT HEREBY REQUESTS PAYMENT OF HIS VACATION BENEFIT AND CERTIFIES AND AGREES THAT THIS APPLICATION IS MADE IN COMPLIANCE WITH THE TERMS AND
CONDITIONS OF THAT CERTAIN TRUST AGREEMENT ENTITLED “TRUST AGREEMENT CALIFORNIA FIELD IRONWORKERS VACATION TRUST FUND,” DATED JANUARY 18, 1962,
AND IN COMPLIANCE WITH THE CONDITIONS OUTLINED IN THE “COLLECTIVE BARGAINING AGREEMENTS” DEFINED IN THAT TRUST AGREEMENT. I FURTHER AGREE THAT
THE SAID VACATION PAYMENT SO REQUESTED IS LIMITED TO AND CIRCUMSCRIBED BY AND ACCEPTED SUBJECT TO THE ABOVE MENTIONED TRUST AGREEMENT,
COLLECTIVE BARGAINING AGREEMENTS, AND THE TERMS AND PROVISIONS OF THIS APPLICATION.
131 N. El Molino Avenue, Suite 330 • Pasadena, CA 91101-1878 • (626) 792-7337 • 1 (800) 527-4613 • FAX (626) 578-0450
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COA001_MARCH2012LMV
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