Vacation Benefit Form IW 433

If you would like your benefit payment electronically deposited to your bank account, please READ AND COMPLETE all portions of this form and return the original signature document totheTrustFundOffice.

I request, until further notice, that disbursements be deposited for each appropriate pay period, to the account with the Financial Institution described on this form and understand that the account cannot be in the name of a living trust or trustee account.

IMPORTANT REMINDER: You must always notify the Trust Fund Office in writing of any change in your mailing address, even though your benefit payment is electronically deposited. The Trust Fund Office does not allow our mail to be forwarded at any time!

Member Name

First Name Last Name

Social Security Number

Account Type

Checking (please attach a voided check) Routing Number Savings (please attach a voided deposit slip indicating the routing and account number)

Routing Number

Account Number

Routing Number

Account Number

Name of Financial Institution

Address of Financial Institution

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Telephone Number

List below names, addresses and Social Security numbers of all parties on this account: (MEMBER WOULD BE LISTED ALWAYS AS #1; EACH ADDITIONAL PERSON ON THIS ACCOUNT MUST ALSO SIGN THIS AGREEMENT. If more space is needed, please add on a separate sheet of paper.

Name of Primary Account Holder

First Name Last Name

Address of Primary Account Holder

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature of Primary Account Holder

Clear

Social Security Number

Name of Co-Account Holder

First Name Last Name

Address of Co-Account Holder

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature of Co Account Holder

Clear

Social Security Number

Name of Co-Account Holder

First Name Last Name

Address of Co-Account Holder

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Signature of Co Account Holder

Clear

Social Security Number

This requestmade under the following conditions: The Financial Institution will receive and receipt to the payee such monies. If, because of lack of knowledge of my death, any payments made by the California Field Iron Worker Vacation Trust Fund Trust, which represent payment for amounts accrued subsequent to my death, I authorize and direct the Financial Institution and/or all additional account holders on said account to correct and cancel the erroneous credits of such monies to my account and refund the amount to the appropriate Fund, as being payments made under a mistake of fact. 131N.El Molino Avenue, Suite 330Pasadena, CA 91101-1878(626) 792-7337 Visit us on the web at www.ironworkerbenny.com Electronic Deposit Authorization_04/30/2019

1(800) 527-4613FAX (626) 578-0450

EMPLOYER ACCOUNTS DEPARTMENT. THANK YOU.

VACATION BENEFIT ELECTRONIC DEPOSIT AUTHORIZATION