Retirement card application

Retirement card application

Office of the General Secretary-Treasurer Dear Sir and Brother, I hereby make application for Retirement Card as provided for by the Constitution.
Email*
exemple@exemple.com
Name*

First nameLast name
Union card number*
Birth date*
Year/month/day
Social insurance number (SIN)*
000 000 000
Last paid wages, vacation, sick leave or severance pay date*
Address*

Number and street

Address complement

CityProvince

Zip code
Phone number*
YesNo
Signature

Effacer
Note: This application to be sent to Grand Lodge with the monthly report on which the Retirement Card is requested.

RULES ON ELIGIBILITY AND POLICY

A member who is retired from his place of employment and is no longer seeking gainful employment of any kind may be entitled to a Retirement Card.

A member who applies for a Retirement Card must at the same time of application pay dues through the month in which the application is dated plus a $10.00 fee. The date of application is the date of retirement and should be the same as the last date for which you received wages, sick pay, vacation pay or separation pay.

If you return to work you must surernder your Retirement Card for cancellation and reapply and pay the $10.00 fee when you again decide to retire.

Application for Retirement Card must be filed timely (within 60 days of last dues payment).

LB10/02
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