Benefit Reciprocity Forms

Contents

Local #1871 Members Belonging to Ohio Carpenters Health & Welfare Fund (Niles) that worked outside of our jurisdiction in the State of Ohio

Local #1871 Members Belonging to Carpenters Hospitalization Plan (Cleveland) that worked outside of our jurisdiction in the State of Ohio

Forms for all work performed in all other Locals Outside of Ohio.

LOCAL #1871 MEMBERS THAT WORKED OUTSIDE OF OUR JURISDICTION NEEDING TO TRANSFER HOURS BACK TO OUR FUND

BLANK ANNUITY TRANSFER FORM (Home Fund – Ohio Carpenters Annuity Fund)

BLANK PENSION FORM (Home Fund – Ohio Carpenters Pension Plan)

SELECT THE HOSPITALIZATION FUND THAT YOU BELONG TO BELOW

BLANK HOSPITALIZATION FORM (Home Fund – Carpenters Hospitalization Plan, Cleveland)

BLANK HOSPITALIZATION FORM (Home Fund – Ohio Carpenters Health & Welfare Fund, Niles)

Travelers Working Within #1871’s Jurisdiction requesting benefits back to their home Local

TRAVELERS THAT WORKED IN OUR JURISDICTION THAT NEED TO TRANSFER HOURS BACK TO THEIR HOME FUND

BLANK ANNUITY TRANSFER FORM

BLANK PENSION FORM

BLANK HOSPITALIZATION FORM

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Favorite Links

Carpenters Service Office – 3611 Chester Avenue, Cleveland, OH 44114 – Phone (216) 361-6190 – Fax (216)361-0142

Carpenters Hospitalization Plan, Ohio Carpenters Pension Plan and Ohio Carpenters Annuity Plan

Ohio Carpenters Health & Welfare Fund

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Last revised: 10/20/2005