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Complete Form 1187 and mail to the LEAGUE. Upon receipt, your state

1187

branch will be notified of your membership. Your monthly dues will

be deducted from your pay and remitted to the LEAGUE by the Postal Service.

Updat

July

Nov08

Check One:

PM/EAS

OIC

PMR

Assoc. Mem

Home Telephone (___) ____________

Date of Birth ______________

Sex

P. O. Telephone (___) _____________

REQUEST AND AUTHORIZATION FOR VOLUNTARY ALLOTMENT

Standard Form No. 1187

Revised August 2000

OF COMPENSATION FOR PAYMENT OF EMPLOYEE ORGANIZATION DUES

U.S. Civil Service Commission

FPM Chapter 550

1187-202

NAME OF EMPLOYEE (Print - Last Name, First, Middle)

SOCIAL SECURITY NUMBER

USPS Employee I.D #

HOME ADDRESS (Street and Number)

City and State

(Zip+4)

Personal Email

OFFICE ADDRESS Home P.O. Finance No. _________ Mail To:

Home

Office E-mail: ______________________________

Post Office _________________________________________________________

(For Office Use Only)

Job Title ________________________________ Designation Code ________

Level of Office: _________________

Exempt

Non-Exempt

STREET ADDRESS ____________________________________________________

CITY _____________________________ STATE _________ ZIP+4 ____________

SECTION A - FOR USE BY EMPLOYEE ORGANIZATION

(For Office Use Only)

NAME OF EMPLOYEE ORGANIZATION (Include local, branch, lodge or other appropriate identification)

N A T I O N A L LE A G U E OF PO S T M A S T E R S

8 H e r b e r t S t . ,

A l e x a n d r i a , Vi r g i n i a 22 3 05

I hereby certify that the regular dues of this organization for the above named member

are currently established at $ _____ per calendar month.

SIGNATURE AND TITLE OF AUTHORIZED OFFICIAL

DATE

SECTION B - AUTHORIZATION BY EMPLOYEE

I hereby authorize the above named agency to deduct from my pay each period, or the first full pay period of each

month, the amount certified above as the regular dues of the National League of Postmasters (Name of Employee

Organization) and to remit such amounts to that employee organization in accordance with its arrangements with my

employing agency. I further authorize any change in the amount to be deducted which is certified by the above named

employee as a uniform change in its dues structure. I understand that this authorization will become effective the first

pay period following its receipt in the Human Resources Shared Services Center (HRSSC), PO Box 970400, Greensboro,

NC 27497-0400.

I further understand that my dues may only be canceled either by separation from the USPS or by using

USPS Standard Form No. 1188, Revocation of Voluntary Authorization for Allotment of Compensation for

Payment of Employee Organization Dues, and that I may revoke this authorization at any time by filing the

original of such a revocation form with the USPS HRSSC, PO Box 970400, Greensboro, NC 27497-0400. SF

1188 is available on the USPS Intranet on the Forms page. Such revocation will not be effective however until

the first full pay period following March 1st or September 1st of any calendar year, whichever date first

occurs after the SF 1188 is received in the HRSSC, (See ELM Section 925 for full explanation of Cancellation

of Dues Withholding guidelines.) Additional information may be obtained by calling HRSSC at 1-877-477-

3273.

SIGNATURE OF EMPLOYEE

DATE

RECRUITER NAME

PLEASE PRINT

First

Last

Social Security Number

City

State

Zip

WORK PHONE:

HOME PHONE:

DATE

__________________________

1187 - National League Of Postmasters Request And Authorization For Voluntary Allotment Of Compensation For Payment Of Employee Organization Dues

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