DAL FERF Application

Delta Pilots Furlough Emergency Relief Fund Application
Date

MonthDayYear
Date
Pilots Name
DAL EMP
Address
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Base
Email
example@example.com
Number of Household Members
Hire Date

MonthDayYear
Date
Current Aircraft
Monthly Net Income
Member in good standing?
Captain or Firs Officer?
Other Household Income
Mortgage, Utilities, Auto Loan, Misc Loan, 401k Loan, Child Care, Alimony, Child Support, Medical Bills (total) Dental Bills (total), Credit Cards (list each) * *

Financials

Rows	Creditor	Balance	Payment	Ending Date
Mortgage
Utilities
Auto Loan
Auto Loan
Auto Loan
Misc Loan
401k Loan
Child Care
Alimony

If you need additional room, please add a separate sheet.

Cancelof
Have you ever filed for bankruptcy?
If so, when?
Are you in the process of filing for bankruptcy?
Have you applied for assistance from the DPFERF in the past?
If Yes, what date?

MonthDayYear
Date
Current Request Amount $
Please give a detail description of why you are requesting assistance
Assets
Checking
Savings
Money Market
401K
IRA
Home Equity
Home Value
Owed
Please list any of the following:
Other Assets
Other Sources of Income
Do you have the ability to borrow against your 401K?
If approved for a loan I agree to repay within _____ months (60 months max)
At $ ____ / mth
and the last payment being
This loan is a no interest loan.
Applicants signature
Date

MonthDayYear
Date
Please send the application and any other information you feel is pertinent to the following:

Delta Pilots Furlough Emergency Relief Fund Air Line Pilots Association, Int'l - Delta MEC 100 Hartsfield Centre Parkway - Suite 800 Atlanta, GA 30354

Chuck.Stalzer@alpa.org and DalFinance@alpa.org

Chuck Stalzer, DPFERF Chairman

ALL INFORMATION IS CONSIDERED CONFIDENTIAL.
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