Defined Contribution Request for information - Pacific Coast Benefits Trust

SSN :
550-59-9289   Date:  4/1/2020
Last Name:
Ramirez   First Name :   Meg Middle Initial: 
Mailing Address : 140 W Kalmia #201
City :
San Diego   State :   California   Zip Code :   92101
Contact Phone :
214-995-6996   Work Phone :  
Date of Birth :
03/23/1978   Email ID :   [email protected]
Sex :
Female   Marital Status :   Single
Will this information be used for divorce purposes:  No
Spouse's Name:
  Spouse's Date of Birth :   Date of Marriage :  

Are you currently Employed:
Yes   Local Union :   542
Employer Name :(Present or Most Recent Covered Employer) UPS  
Date of Hire :
03/09/2016   Date of Termination :  
Previous Employer :
Date of Hire :
  Date of Termination :  

Have you ever been disabled:
No   From Date :     To Date :      
Are you receiving Social Security Disability Benefits ? No         Entitlement Date :

Have you previously requested pension information : No                Year :