IW 550 Reciprocal Cards

IRON WORKERS LOCAL 550 FRINGE BENEFITS FUND

TOLL FREE (800) 296-5160
Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
Date
Address*

Home Address

Street Address Line 2

CityState

Postal / Zip Code
Last 4 of SSN*
Home Phone No.*
Local Union #*
Membership #*
PLEASE COMPLETE ALL 4 SECTIONS
Elect Do not elect* I request all contributions submitted on my behalf to the Health Care Fund be remitted to: Local # Home Local #* , my home fund.
Elect Do not elect* I request all contributions submitted on my behalf to the Defined Benefit Pension be remitted to: Local # Home Local #* ,my home fund.
Elect Do not elect* I request all contributions submitted on my behalf to the Security Fund be remitted to: Local # Home Local #*, my home fund.
Elect Do not elect* I request all contributions submitted on my behalf to the Account Fund be remitted to: Local # Home Local #*, my home fund.
THE FUND WHERE I WISH MY CONTRIBUTIONS BE TRANSFERRED TO IS*
In consideration of the Funds making the transfer per this authorization and request, I hereby agree, on behalf of myself, my dependents and heirs, to hold the Fund and their respective Trustees, together with them and their successors harmless from any claims or damages which might result from such transfer. I fully realize that the transfer of employer contributions from either Fund to my respective "Home Fund" might not actually work to my best interest.
Date Signed*

MonthDayYear
Date
SIGNATURE *

Clear
This card must be signed and returned to the Fund office within 30 days from date of commencing work in this plan's jurisdiction.

If you have ANY questions or need help completing this card, please call our office.

In regard to the Annuity/Security Funds, some funds are known as Annuity Funds and some are known as Security Funds.
Should be Empty:

IRON WORKERS LOCAL 550 FRINGE BENEFITS FUND

PLEASE COMPLETE ALL 4 SECTIONS