U          U NION TRUSTEES

 James Buchanan

Thomas J. Kotel

John E. Kuszynski

Gregory J. Watson

Pipe Fitters' Local 597

 

W e l f a r e  &  R e t i r e m e n t  F u n d s

PETER A. DRISCOLL, ADMINISTRATOR

 

45 North Ogden Ave. ♦   Chicago, Illinois 60607

ph 312.633.0597 ♦   fax 312.829.7787

www.pf597.org




 
       EMPLOYER TRUSTEES

Frederick S. Oyer

John D. Curran

Victor Giometti

Stephen L. Lamb

 

 

 

BENEFICIARY DESIGNATION FOR DEATH BENEFITS

Pipe Fitters Welfare Fund, Local 597

 

   Single Beneficiary:  I would like the following individual to receive my entire Pipe Fitters Local 597 Welfare Fund Death Benefit.

Name 

Relationship 

  Address 

City 

State 

 

- or -

    * Multiple Beneficiaries:  I would like the following person(s) to receive my Death Benefits (if division is other than     equal shares, write in percentages):

Name      

Address 

Relationship 

Percent 

Name    

Address 

Relationship 

Percent 

Name    

Address 

Relationship 

Percent 

Name    

Address 

Relationship 

Percent 

 

Note:  This beneficiary designation applies ONLY to your Death Benefit under Pipe Fitters Welfare Fund,       Local 597

 

 

Participant I.D. Number 

 

Social Security # 

 

Print Participant Name 

 

Participant Signature 

 

Date 

  

* If you select a Single Beneficiary to receive all your Welfare Fund Death Benefits, you may also list individual(s) under “Multiple Beneficiaries” who would receive your Death Benefits in the event the Single Beneficiary pre-deceases you.