SAG-PRODUCERS PENSION PLAN
3601 W. Olive Ave., Burbank, CA 91505 • Mailing Address: P.O. Box 7830, Burbank, CA 91510-7830
P (800) 777-4013 • F (818) 973-4467 • www.sagaftraplans.org/sag-pension
Pension Applicant Information Form
To begin the retirement process, please complete and return this application (please print).
Name
Last:
First:
Middle:
Professional name
Last:
First:
Middle:
Address
Street:
City:
State:
Zip:
Phone:
Email:
Social Security number Gender
Male Female
Date of birth (MM/DD/YYYY) U.S. citizen
/ /
Yes No
Desired effective date of pension (MM/YYYY)
/
Records of employment and earnings under Screen Actors Guild Agreements from 1937 to 1960:
Submitted here Submitted previously Not applicable
I am applying for a pension from the Screen Actors Guild-Producers Pension Plan for Motion Picture Actors. I certify
that all statements made in this application are true and correct to the best of my knowledge. I understand that
this application will not be considered valid unless it is complete.
Participant signature
Date
For office use only
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