IW 92 - REQUEST FOR VACATION FUND WITHDRAWAL

REQUEST FOR VACATION FUND WITHDRAWAL

(mark Change of Address, if applicable)
Hold For Pick Up

Check this box to request that your check be held at the Union Hall for you to pick up. See Pick-Ups below for restrictions.
Amount Requested for Withdrawal*
IF YOU DO NOT FILL IN THE AMOUNT REQUESTED, YOU WILL NOT RECEIVE A CHECK
Name*

First NameMiddle Initial Last Name
SSN*
Local #*
Phone Number*
Please enter a valid phone number.
Email
Enter email to receive a copy
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note: If your address on this form is different from your address on file at Iron Workers Local No. 92, your address will be changed to the above address.

I have read and understand the policies outlined on this form and I understand that this withdrawal is governed by the Rules and Regulations described in the Vacation Fund Rules and Regulations. I understand that two withdrawals are permitted during each calendar year.
Change of Address

Check this bow if you need to update/change your address
Street Address*
City, State, Zip*
Signature*

Clear
Date*

MonthDayYear
Pick-Ups: You must provide an official picture I.D. (such as a driver license, passport or state I.D. Card) If you do not have an official I.D. available, your check will be mailed.

Please read the following carefully regarding your Vacation Fund Withdrawal.

1. No Vacation Fund Check will be issued without this Form being received by Iron Workers Local No. 92. This form must contain the dollar amount you wish to withdraw and must be signed by the Union Member.

2. If you choose to withdraw a partial amount of your Vacation Fund Balance, the remaining funds will remain in your account and will be reflected on your next statement.

3. Only two Vacation Withdrawal Requests are permitted during each calendar year.
Should be Empty: