This form may be returned to us either by email, fax 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.
Para obtener asistencia en Español, llame al 1-800-527-4613 131 N. El Molino Avenue, Suite 330Pasadena, CA91101-1878(626) 792-7337
FAX (626) 529-1351