Iron Workers Local 8

Disclaimer

Working Due Check-off Authorization

I hereby authorize any of the various individual Employers who are signatory to a collective bargaining agreement with Iron Workers Local No. 8, hereafter called "union" or the International Association of Bridge & Structural Iron Workers, AFL-CIO, and by whom I may be employed during the terms of such agreement, or any renewal or extension, or any subsequent agreement, to deduct from my wages and transmit monthly to said Union the sum which the Union has specified, or specifies from time to time, as the portion of my hourly working dues to said Union, subject to check-off through procedures conforming to applicable law. This authorization shall be irrevocable for a period of one (1) year following the date it was signed or until the current applicable collective bargaining agreement expires, whichever occurs sooner. This authorization shall be automatically renewed from year to year, unless at least thirty (30) days and not more than forty-five (45) days prior to the termination or the annual renewal date I revoke this authorization by written notice to the Union and to the individual employer by whom I am employed.

Authorization for Representation

I hereby authorize Iron Workers Local No. 8 to be my exclusive collective bargaining representative in all matters relating to wages, hours, and conditions of employment with my present employer and all subsequent employers performing work within the jurisdiction of Iron Workers Local No. 8.

Authorization of Contributions Transfer

I understand that the Cooperating Fund will act solely as the agent of the noted Home Fund and as such, I shall be subject to the eligibility rules of said Home Fund upon the transfer of contribution. I hereby release (on behalf of myself as well as on behalf of anyone claiming through me) and further discharge the Cooperating Fund and their Trustees of and from all claims, demands, actions, causes of actions or suites 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. I further recognize that the transfer of contributions to the noted Home Fund may or may not ultimately prove to be to the advantage of myself and/or my beneficiaries.

Request for transfer of pension fund contributions

As provided in the Reciprocity Agreement between your Pension Fund and my Home Fund, I am requesting you transfer to my Home Fund all Pension Fund contributions received by you in my behalf.

I understand that if I have become a Participant in the Transferring Fund, ONLY contributions received in my behalf after the date you receive the appropriate Transfer Request Form may be transferred to my Home Fund. If I am not a Participant in the Transferring Fund, ALL contributions received by the Transferring Fund in my behalf may be transferred to my Home Fund upon receipt of the appropriate Transfer Request Form. NOTE: In Building Trades United Pension Trust Fund, Participation occurs on the June 1 or December 1 after performing 750 hours of work under a written agreement which requires contributions to Building Trades United Pension Trust Fund.

If this request is approved, I, my dependents, survivors and beneficiaries will no longer have any claim against you for the contributions transferred or for any benefits which may have been payable in my behalf. My eligibility for any benefits based on these contributions will be determined by the Plan provisions of my Home Fund.

These instructions will continue in effect until I direct you, in writing, to cease transferring contributions to my Home Fund. I understand you may require annual verification of this request.