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**Please make sure your beneficiary information is current!**

Pension Forms


RETIREMENT Application (with instructions)

Change of Address

Electronic Deposit Form (For Retiree Pension Payments only)

Beneficiary Card

Rollover Elections

Equity to Fixed 50 years or older

Sample Qualified Domestic Relations Order

Summary of Material Modification (April 2010)

Election Form - Age 70 1/2

Notice of Material Modification (Termination of Employment)

Separation of Employment Distribution Application

 

If not indicated, all forms should be sent to:
United Administrative Services
c/o IBEW Local 617 Pension Trust Fund
PO BOX 5057
San Jose, CA 95150-5057

www.uastpa.com