Ironworkers' International Reciprocal Agreement

Ironworkers' International Reciprocal Agreement

Contributions Authorization Transfer
Iron Workers Local 25

(248) 344-9494
Name *

First Name Last Name
Email *
Address *

Street Address

City State / Province

Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number *
Please enter a valid phone number.
SS # *
Home Local # *
Union Book #
Birth Date *

Month Day Year
Date
I hereby elect or do not elect as indicated below, to have contributions that are paid on my behalf to the following Funds, transferred to my Home Funds. I understand that this authorization is only valid with respect to those cooperating funds that have executed agreements with my Home Fund to permit the transfer of contributions.
Please select one of the following

Elect Do Not Elect to have my Health & Welfare contribution remitted to my Home Fund
Please select one of the following

Elect Do Not Elect to have my Pension contribution remitted to my Home Fund
Please select one of the following

Elect Do Not Elect to have my Defined Contribution Annuity remitted to my Home Fund
I understand that the cooperating Fund(s) will act solely as the agent of the noted Home Fund(s); and as such, I shall be subject to the eligibility rules of said Home Fund(s) upon the transfer of contributions. I hereby release (on behalf of myself as well as on behalf of anyone claiming through me) and further discharge the cooperating fund(s) and their Trustees of and from all claims, demands, actions, causes of actions or suits with respect to any contributions so transferred and for any benefits or credits which would have accrued or become payable to me had I not authorized this transfer of contribution. I further recognize that the transfer of contribution to the noted Home Funds may or may not ultimately prove to be to the advantage of myself and/or my beneficiaries.
I was or am currently employed by
Jobsite Name
Job Steward Name
Travel Dues paid? Answer yes or no
Signature

Clear
Date

Month Day Year
Date
SECTION 1: WORKING DUES ASSESSMENTS AUTHORIZATION

I hereby assign to Local 25, International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers, AFL-CIO fom the vested contributions made by my employer(s) to Iron Workers Local 25 Vacation Fund the sum as set forth in Article 11, Paragraphs (C) and (D) of the Iron Workers Local 25 By-Laws. This is in accordance with the International Constitution of Bridge, Structural, Ornamental and Reinforcing Iron Workers.
SECTION 2: TARGETING FUND ASSESSMENTS AUTHORIZATION

I hereby assign to Local 25, International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers, AFLCIO from the vested contributions made by my ernployer(s) to Iron Workers Local 25 Vacation Fund the sum as set forth in Article XII, Paragraph (F) of the Iron Workers Local 25 By-Laws. These contributions will be used for maintaining and promoting any type of work within the realm of the Organized Iron Working industry within the jurisdiction of Iron Workers Local 25 as per Article XIV (Organizing) Local 25 By-Laws
Signature

Clear
Date

Month Day Year
Date
In order to comply with the Affirmative Action policy of the DOL we ask that you provide us with the following information. Your voluntary cooperation is appreciated with this DOL information.

African America American Indian/Alaskan Native Asian/Pacific Islander Caucasian (Other) Hispanic
Should be Empty:

Ironworkers' International Reciprocal Agreement

Iron Workers Local 25

SECTION 1: WORKING DUES ASSESSMENTS AUTHORIZATION

SECTION 2: TARGETING FUND ASSESSMENTS AUTHORIZATION