Last Name – Your last name.
First Name – Your first name.
Middle Initial – Your middle initial.
Mailing Address – Your mailing address.
City, State, Zip – Your city, state and zip code.
Contact Phone – Your contact phone number including area code.
Work Phone – Your work phone number including area code (optional).
Date of Birth – Your date of birth in MM/DD/YYYY format.
Sex – Your sex.
Marital Status – Your marital status.
Is this info used for divorce proceedings? – Click the appropriate button that applies to your situation.
Spouses Name – If married or separated enter your spouse’s name.
Spouses Date of Birth – If married or separated enter your spouse’s date of birth in MM/DD/YYYY format.
Date of Marriage - Your date of marriage in MM/DD/YYYY format.
Are you currently Employed? – Click on the Yes button if you are currently employed by an Employer covered under a collective bargaining unit represented by a union under this Pension Fund. Otherwise click the No button.
Local Union – The local union number that you last worked under as a Covered Employee.
Employer Name – The name of your most recent Covered Employer.
Date of Hire – Your date of hire in MM/DD/YYYY format. The month and year fields are required. If you do not know the exact day that you were hired please leave the DD field blank.
Date of Termination – If you are no longer working under this Pension Fund, please enter your date of termination in MM/DD/YYYY format. If you enter a date of termination the month and year fields are required. If you do not know the exact day that you terminated please leave the DD field blank.
Previous Employer – Name of previous employer, if applicable.
Date of Hire - Your date of hire in MM/DD/YYYY format. The month and year fields are required. If you do not know the exact day that you were hired please leave the DD field blank.
Date of Termination - Your date of termination if applicable in MM/DD/YYYY format. If you enter a date of termination the month and year fields are required. If you do not know the exact day that you terminated please leave the DD field blank.
Have you ever been disabled? – Click on the appropriate button that applies to situation.
From Date – If you have been disabled please provide the MM/YYYY that you became disabled.
To date – If applicable enter the date your disability ceased. If a date is entered it must be in MM/YYYY format. If you are currently disabled leave this field blank.
Are you receiving Social Security Disability Benefits? – Required field if you answered yes to the question above “Have you ever been disabled”.
Entitlement Date – If you are receiving Social Security Disability Benefits, please provide your Entitlement Date. Must be in MM/DD/YYYY format. The day of your entitlement must be the 1st day of the month.
I am requesting an Estimate of Benefits for Retirement at Age – Enter the age in which you would like the quote based on.
I am requesting an Estimate of Benefits based on the elected retirement date of- Enter the elected date you would like the quote based on. Must be in MM/DD/YYYY format. The day must be the 1st day of the month.
I am requesting an Estimate of Death Benefits – Click this box if you are requesting an estimate for death benefits.
Have you previously requested pension information? – Click the appropriate button that applies to your situation. If you have previously requested pension information and can remember the year, please provide that information in YYYY format.
Last Name – Your last name.
First Name – Your first name.
Middle Initial – Your middle initial.
Mailing Address – Your mailing address.
City, State, Zip – Your city, state and zip code.
Contact Phone – Your contact phone number including area code.
Work Phone – Your work phone number including area code (optional).
Date of Birth – Your date of birth in MM/DD/YYYY format.
Sex – Your sex.
Marital Status – Your marital status.
Is this info used for divorce proceedings? – Click the appropriate button that applies to your situation.
Spouses Name – If married or separated enter your spouse’s name.
Spouses Date of Birth – If married or separated enter your spouse’s date of birth in MM/DD/YYYY format.
Date of Marriage - Your date of marriage in MM/DD/YYYY format.
Are you currently Employed? – Click on the Yes button if you are currently employed by an Employer covered under a collective bargaining unit represented by a union under this Pension Fund. Otherwise click the No button.
Local Union – The local union number that you last worked under as a Covered Employee.
Employer Name – The name of your most recent Covered Employer.
Date of Hire – Your date of hire in MM/DD/YYYY format. The month and year fields are required. If you do not know the exact day that you were hired please leave the DD field blank.
Date of Termination – If you are no longer working under this Pension Fund, please enter your date of termination in MM/DD/YYYY format. If you enter a date of termination the month and year fields are required. If you do not know the exact day that you terminated please leave the DD field blank.
Previous Employer – Name of previous employer, if applicable.
Date of Hire - Your date of hire in MM/DD/YYYY format. The month and year fields are required. If you do not know the exact day that you were hired please leave the DD field blank.
Date of Termination - Your date of termination if applicable in MM/DD/YYYY format. If you enter a date of termination the month and year fields are required. If you do not know the exact day that you terminated please leave the DD field blank.
Have you ever been disabled? – Click on the appropriate button that applies to situation.
From Date – If you have been disabled please provide the MM/YYYY that you became disabled.
To date – If applicable enter the date your disability ceased. If a date is entered it must be in MM/YYYY format. If you are currently disabled leave this field blank.
Are you receiving Social Security Disability Benefits? – Required field if you answered yes to the question above “Have you ever been disabled”.
Entitlement Date – If you are receiving Social Security Disability Benefits, please provide your Entitlement Date. Must be in MM/DD/YYYY format. The day of your entitlement must be the 1st day of the month.
I would like a quote for a Monthly Annuity Benefit based on the elected retirement date of – If you would like an employee of the Administrative Office to provide you with a quote for a Monthly Annuity Benefit, please click this box and enter the elected retirement date you would like the quote based on. The date must be in MM/DD/YYYY format. The day must be the 1st day of a month.
Have you previously requested pension information? – Click the appropriate button that applies to your situation. If you have previously requested pension information and can remember the year, please provide that information in YYYY format.