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CARPENTER FUNDS ADMINISTRATIVE OFFICE OF NORTHERN CALIFORNIA 265 (Carpenter Funds Administrative Office)

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opeiu 29 afl-cio (125) PENSION 4/2018
CARPENTER FUNDS ADMINISTRATIVE OFFICE
OF NORTHERN CALIFORNIA
265 Hegenberger Road, Suite 100 Oakland, CA 94621
PO Box 2280, Oakland, California 94614
Tel. (510) 633-0333 (888) 547-2054 Fax (510) 633-0215
www.carpenterfunds.com benefitservices@carpenterfunds.com
DIRECT DEPOSIT FORM
CARPENTERS PENSION TRUST FUND
FOR NORTHERN CALIFORNIA
The undersigned hereby authorizes the Carpenters Pension Trust Fund for Northern California to make credit
entries, and if necessary, to make debit entries as adjustments for any credit in error, to my bank account
indicated below. I also authorize accordingly my financial institution indicated below to credit and/or debit the
same to such account.
Authorization Information
I hereby authorize Carpenters Pension Trust Fund for Northern California to directly deposit my benefit
payments via electronic funds transfer into my:
Checking Account (You must attach below a voided check for your checking account.)
Savings Account (You must attach below a deposit slip with routing number for your savings account.)
PLEASE NOTE: If you do not have the required documents to attach below, you can provide a bank stamp from
your financial institution indicating your name, account number, routing number and the type of account
(checking or savings).
This authority is to remain in full force and effect until the Carpenters Pension Trust Fund for Northern California
has received written notification from me of its termination in such time and in such manner as to afford the
Trust Fund Office and my Financial Institution a reasonable opportunity to act on it.
Please Print Name:
UBC#, SSN or CFAO ID #:
Phone #:
Street Address:
City:
State:
Zip Code:
Signature: Date Signed:
Account Information
*Please attach a voided check for your checking account.
(see example below)
(see example below)
PLEASE NOTE: If you do not have the required documents to attach, you can provide a bank stamp from your financial
institution indicating your name, account number, routing number and the type of account (checking or savings).
To Update your Record: Complete each page of the form, print it, sign it and return it via email, fax or mail.
Reset Form
opeiu 29 afl-cio (125) PENSION 4/2018
PLEASE READ THIS CAREFULLY
All information on this form is required. The information is confidential and is needed to prove entitlement to
payment. The information will be used to process payment data from the Carpenters Pension Trust Fund to
the financial institution and/or its ag
ent. Failure to provide the requested information may affect the processing
of this form and may delay or prevent the receipt of payments through the Direct Deposit/Electronic Funds
Transfer Program.
SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS
Joint account holders should immediately advise both the Carpenters Pension Trust Fund and the financial
institution of the death of a retiree. Funds deposited after the date of death or ineligibility are to be returned to
the Pension Fund. The Carpenters Pension
Fund will then make a determination regarding the survivor rights,
calculate survivor benefit payments, if any, and begin payments.
Under the terms of the Pension Plan and
the Trust Agreement establishing the Pension Fund, the Trustees are entitled to rec
over any and all
overpayments of Pension benefits from the retiree, the beneficiary and/or the estate of the retiree. In
the event that the Pension Fund is not timely notified of the retiree’s death, the Pension Fund will have
no alternative but to recover any amounts overpaid from the retiree’s estate or beneficiaries.
CANCELLATION
The agreement represented by this authorization remains in effect until cancelled by the recipient by notice to
the Carpenters Pension Trust Fund or by death or legal incapacity of the recipient.
CHANGING RECEIVING FINANCIAL INSTITUTIONS
The payee’s Direct Deposit will continue to be received by the selected financial institution until the Carpenters
Pension Trust Fund is notified by the payee that the payee wishes t
o change the financial institution receiving
the Direct Deposit. To effect this change, the payee will complete a new Direct Deposit Form for the newly
selected financial institution. It is recommended that the payee maintain accounts at both financial i
nstitutions
until the transition is complete, i.e. after the new financial institution receives the payee’s Direct Deposit
payment.
FALSE STATEMENTS OR FRAUDULENT CLAIMS
Federal law provides a fine of not more than $10,000 or imprisonment for not more than five (5) years or both
for presenting a false statement or making a fraudulent claim.
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CARPENTER FUNDS ADMINISTRATIVE OFFICE OF NORTHERN CALIFORNIA 265 (Carpenter Funds Administrative Office)

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Completed 13 January 2021

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