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Skip Navigation LinksHome » Supplemental Forms  

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Appeal Form

Use this form to appeal a denial of benefits from the Supplemental Retirement Fund.

Beneficiary Designation Form

This form may be used to designate beneficiaries who would receive benefits from the Supplemental Retirement Plan in the event of your death prior to distribution directly to you.  It is recommended, although not legally required, that all vested Participants complete a Beneficiary Designation form that can be retained in the Pension Fund Office.

Distribution Form - Direct Deposit (EFT) Information Form

This form has instructions on how to set up direct deposit (Electronic Funds Transfer) for a Supplemental Retirement Plan distribution. If direct deposit information is not set up PRIOR TO your distribution application being processed, the distribution will be processed in the form of a paper check. Note that direct deposit is not available for rollover distributions.

Distribution Form (In-Service or Hardship) & Special Tax Notice

Use this form to apply for a distribution before termination. If applying for a Hardship Distribution, supporting documentation (listed on the form) must be submitted with this form.

Distribution Form (Termination) & Special Tax Notice
Complete this form to apply for a distribution if one of the following situations apply:   (1) you have retired and you have begun receiving pension benefits from the Defined Benefit Pension Plan; (2) you have not had an hour of service for at least 24 consecutive months; or (3) you are permanently disabled. If applying for withdrawal due to total and permanent disability, a completed Medical Examination Report must be submitted with this form. Note: The Federally required Tax Notice will appear at the top, the form will follow.
Distribution Rollover Form
Use this form to provide information needed to make a direct rollover of all or a portion of your In-Service distribution or Termination distribution from the Plan to an individual retirement account (“IRA”) or another qualified plan. This form must be accompanied by either the In-Service Distribution form or the Termination Distribution form.
Formulario de Distribución – Forma Informativa para Deposito Directo (EFT)
Esta forma tiene instrucciones de como se puede establecer un deposito directo (Transferencia de Fondos Electrónicos) a su cuenta de banco para una distribución del Plan de Retiro Suplemental. Si no se establece un depósito directo antes de que su aplicación se haya procesado, su distribución será procesada en forma de un cheque. Anote que para una reinversion directa no se puede utilizar el depósito directo. 
Formulario de Distribución (En Servicio o Dificultad Financiera) y Los Avisos Legales Sobre los

Este formulario es para retirar fondos antes de terminación. Si estas aplicando para una distribución por razón de una dificultad financiera, los comprobantes (anotados en el formulario) deben de ser sometidos juntos con este formulario.

Formulario de Distribución (Terminación) y Los Avisos Legales Sobre los Beneficios del Plan
Si uno de los siguientes casos le aplica a usted; llene este formulario para solicitar una distribución de terminación: (1) si estas jubilado y has empezado a recibir beneficios de pensión del Plan de Pensión con el Fondo; (2) si no has tenido una hora de servicio por un periodo de 24 meses consecutivos; o (3) si estas permanente incapacitado. Si estas solicitando una distribución por razón de incapacidad, el formulario de Examen  Medico tiene que ser sometido junto con este formulario.
Anote: Los Avisos Legales Sobre los Beneficios del Plan aparece primero, la forma sigue.
Formulario de Reinversion Directa

Utilicé este formulario para dar la información necesaria para poder reinvertir todo o una porción de su distribución por razón de Terminación o una Distribución en Servicio, del plan suplemental a una cuenta de retiro individual (“IRA”) u otro plan calificado. Este formulario tiene que ser acompañado con el formulario de Distribución en Servicio o el formulario de Distribución de Terminación.

Formulario para Designar Beneficiarios

Este formulario se puede usar para designar sus beneficiarios quienes recibirían sus beneficios del Plan de Retiro Suplemental en dado caso de que usted fallezca antes de recibir su distribución. Es recomendado, pero no es legalmente necesario, que todos los participantes con intereses creados llenen el Formulario para Designar Beneficiarios; que se puede retener en la Oficina del Fondo de Pensión.

Medical Examination Report – Supplemental Retirement Plan

This completed form must be submitted with a Distribution Form (Termination) if you are applying for a distribution due to total and permanent disability. If you are receiving Social Security Disability, a copy of your SSD award letter can be submitted in lieu of this form.

Plan Investments Booklet

This booklet contains information about the investment options currently offered in the Supplemental Retirement Plan.

QDRO – Divorce Packet Request Form

Use this form to request personalized information about your account in relation to divorce proceedings.

QDRO – Model – Supplemental Retirement Plan

This form can be used as a guideline in drafting a Qualified Domestic Relations Order to assign a portion of your account to an Alternate Payee.

QDRO – Procedures – Supplemental Retirement Plan

This document outlines the Supplemental Retirement Plan’s procedures for handling Qualified Domestic Relations Orders.

Retirement Plan Details Booklet

This booklet contains general information about the features of the Supplemental Retirement Plan.

Retirement Plan Details Booklet (In Spanish) - Detalles del plan de Retiro
Este folleto contiene información general sobre las características del Plan de Retiro Suplemental.
Supplemental Retirement Plan - Fund Change Notice

Information on changes to the investment lineup that are effective 12/23/2011.

Supplemental Retirement Plan – Plan Document
Supplemental Retirement Plan – Summary Plan Description
 
 

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