Electrical/equipment operator

Location:

Posted:

March 25, 2025

etal Workers! Loeal No. .) Profit Sharlig Anwulty Mund

Venellt Distribution Application

Abpticntion Cheoktia

Thoase wtiltie the chook iat below: to ervuire that you have: completed your application filly

Tis will expentite the apptioatlon process, Misalng documents and Incomplete application

Roca welll delay the proceaalag of your application, Review the fooma you are sub

Wo wake sure that you AML lo all blanks (ise "NA" fie those that do not apply),

Qusstions accurately and cewnpletely, ant sige with date as requested (a Notary Public

MUST witness your signature where Ayysticabte)

wn litling

QO Appication form

OQ Contiffoation of Martial Single Status

O Statement of Current Finptoy ment

QO Altidavit of Termination

Q Determination of Retirement

C) Photo Tp :

O Beth Corbi reate

Return items listed above to:

Sheet Metal Workers Local 33

Profit Sharing Anaulty Fund

12315 Corporate Drive

Panna OH 44130

DISTRIB

BENEFIT ELECTION

[Ascnat Member §1606-1-1 [Sree hare Shoot Metal Workers’ Local 33

[Pa Neve Sheet Metal Workers’ Local 33 Prot Sharing Annuity Pian :

[Payee (dheck ore Former Erployve who Condiwed Account DO Spaite Benetcery

Former Employee recehing Instaiment Payments — [7] Non-spoure Benetiiary —_[[) Active 6% Owner Age 70M or older

[PAYEE INFORMATION (Please print)

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