Vacation Benefit Electronic Deposit Authorization

If you would like your benefit payment electronically deposited to your bank account, please READ AND COMPLETE all portions of this form and return the original signature document to the Trust Fund Office.

I request, until further notice, that disbursements be deposited for each appropriate pay period, to the account with the Financial Institution described request, on this form and understand that the account cannot be in the name of a living trust or trustee account.

IMPORTANT REMINDER: You must always notify the Trust Fund Office in writing of any change in your mailing address, even though your benefit payment is electronically deposited. The Trust Fund Office does not allow our mail to be forwarded at any time!

List below names, addresses and Social Security numbers of all parties on this account: (MEMBER WOULD BE LISTED ALWAYS AS #1; EACH ADDITIONAL PERSON ON THIS ACCOUNT MUST ALSO SIGN THIS AGREEMENT.) If more space is needed, please add on a separate sheet of paper.

This request is made under the following conditions: The Financial Institution will receive and receipt to the payee such monies. If, because of lack of knowledge of my death, any payments made by the California Ironworkers Field Pension Trust, which represent payment for amounts accrued subsequent to my death, I authorize and direct the Financial Institution and/or all additional account holders on said account to correct and cancel the erroneous credits of such monies to my account and refund the amount to the appropriate Fund, as being payments made under a mistake of fact.

131 N. El Molino Ave., Suite 330, Pasadena, CA 91101-1878 • 626-792-7337 • 800-527-4613
Fax 626-678-0450 • Visit us on the Web at
www.ironworkerbenny.com 
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