IW 378 Address Form

CALIFORNIA FIELD IRONWORKERS TRUST FUNDS

Pension Trust • Welfare Plan • Vacation Trust • Apprenticeship Training & Journeyman • Retraining Fund Annuity Trust • www.ironworkerbenny.com
ADDRESS FORM
For new employee information and all address changes this form MUST BE COMPLETED IN ITS ENTIRETY. Should this form be receied y the Trust Fund office with information missing or illegible, it will be returned for recompletion and/or correction, which will cause a delay in the processing of these changes.
Name

Last NameFirst NameMiddle Initial
Date of Birth

MonthDayYear
Date
SSN
Gender

MaleFemale
Local Union No
New Address Information

Completing this form will permanently change your address with the Trust Fund Office. This change will remain in effect until either a new Address Form is completed or returned mail is received by our office, at which time your address will be made bad and no further items will be sent including Vacation Checks.
Members Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Member Signature

Clear
Emergency Contact Info
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
***IMPORTANT INFORMATION***
The Trust Fund Office WILL NOT accept these forms via fax or email. This form must be returned to us either in person 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 Ave., Suite 330 • Pasadena, CA 91101-1878 • (626) 792-7337
(800) 527-4613 • FAX (626) 578-0450 • www.ironworkerbenny.com
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CALIFORNIA FIELD IRONWORKERS TRUST FUNDS

Emergency Contact Info

***IMPORTANT INFORMATION***

IMPORTANT INFORMATION