Reciprocal Agreement Authorization of Contributions Transfer

Ironworker International Reciprocal Agreement Authorization of Contributions Transfer
Member Name*
Email Address*
Street*
City*
State*
Zipcode*
Phone Number*
Social Security Number*
Date of Birth*

MonthDayYear
Date
Book Number*
Home Local Union #*
Visiting Local Union #*
I hereby elect or do not elect as indicated below, to have contributions, which are paid on my behalf to the following Funds, transferred to my Home Local Union Fund. I understand that this Authorization is only valid with respect to those Cooperating Funds that have executed agreements with my Home Local Union Fund to permit the transfer of contributions.
Welfare*

ElectDo Not Elect to have my Welfare contributions remitted to my Home Fund
Pension*

ElectDo Not Elect to have my Pension contributions remitted to my Home Fund
Annuity*

ElectDo Not Elect to have my Annuity contributions remitted to my Home Fund
I understand that the Cooperating Fund(s) will act sorely as the agent of the noted Home Local Union Fund(s) and as such, I shall be subject to the eligibility rules of said Home Local Union Fund(s) upon the transfer of contributions. I hereby release (on behalf of myself as well as on behalf of anyone claiming through me) and further discharge the Cooperating Fund(s) and their Trustees of and from all claims, demands, actions, causes of actions of suits with respect to any contributions so transferred and for any benefits or credits which would have accrued or become payable to me had I not authorized this transfer of contributions(s). I further recognize that the transfer of contributions(s) to the noted Home Local Union Fund(s) may or may not ultimately prove to be to the advantage of myself and/or my beneficiaries.
Today's Date*

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Date
Signature*

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Ironworker International Reciprocal Agreement Authorization of Contributions Transfer