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CARPENTERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA 265 (Carpenter Funds Administrative Office)

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CARPENTERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA
265 Hegenberger Rd, Suite 100, Oakland, CA 94621
Tel (888) 547-2054 or (510) 633-0333 Fax (510) 633-0215
www.carpenterfunds.com
INSTRUCTIONS
1. Read and answer each question carefully.
2. Print all information. Incorrect or incomplete information will delay Pension benefits.
3. Sign and date your Application.
4. Anticipate the Pension Application process to take 60-90 days.
5. Mail completed application to the Fund Office and keep a copy of the completed application for your
records.
REQUIRED PROOF DOCUMENTS CHECKLIST (PHOTOCOPIES OK)
Certified Birth Certificate for you and your spouse* from County Recorder’s Office
OR Copy of Passport OR Original Naturalization record.
Certified Marriage Certificate from the County Recorder’s Office.
If divorced, please submit a complete copy of your divorce decree(s) and Marital Settlement Agreement(s).
*If a Birth Certificate is not available, TWO of the following items may be submitted instead:
Military Record
School Records, certified by the custodian of such record
An insurance policy which shows the age or date of birth
Marriage records showing dates of birth/age (application for marriage license or church record;
certified by the custodian of such record; or marriage certificate)
Baptismal certificate/statement confirming date of birth in church records, certified by the custodian
of such records
Notification of registration of birth in a public registry of vital statistics
Hospital birth record, certified by the custodian of such record
A foreign church or government record
A signed statement by the physician or midwife who attended the birth
Signed notarized statements from persons with knowledge of the birth
ADDITIONAL POSSIBLE PROOF REQUIREMENTS
When applying for a SERVICE, EARLY OR DISABILITY PENSION, additional documents maybe required.
Please see page 2 of this Application for more information.
Copy of Social Security Disability Entitlement Award Letter
(Within 90 days of issue date for possible retroactive effective date)
Possible IRS 1040 & W-2 tax forms or Detailed Earning report from Social Security
REFER TO PAGE 7 FOR MORE REFERENCE MATERIAL
FAILURE TO PROVIDE REQUIRED DOCUMENTS WILL DELAY PROCESSING OF YOUR APPLICATION
PLEASE EXPECT 60-90 DAY PROCESSING TIME
PLEASE RETURN ALL PAGES OF THIS APPLICATION
Pension Application for Retirement
opeiu 29 afl-cio (125) 5/2018
To Apply for your Carpenters Pension: Complete each page of the form, print it, sign it and return it via email, fax or mail.
2
Pension Fund
CARPENTERS PENSION TRUST FUND FOR NORTHERN CALIFORNIA
265 Hegenberger Rd, Suite 100, Oakland, CA 94621
Tel (888) 547-2054 or (510) 633-0333 Fax (510) 633-0215
www.carpenterfunds.com
PENSION APPLICATION
PERSONAL INFORMATION
Name: ___________________________________________________________________________________________
Last First Middle Initial
CFAO ID #, UBC # or Social Security Number: ___________________________________________________________
Date of Birth: ________________________________ Telephone Number: (_______)_____________________________
Area Code
Address: _________________________________________________________________________________________
Street
_________________________________________________________________________________________________
City State Zip Code
Email Address for receipt of Mandatory Disclosures: _______________________________________________________
(If email provided, mandatory disclosures will be sent via email, see page 7 for more information.)
Please submit photocopies of the following documents with your Application for benefits:
Certified Birth Certificate from County or passport for you AND your spouse
Certified Marriage Certificate filed with the County Recorder
If you have been divorced, please submit a complete copy of your divorce decree(s) and Marital Settlement
Agreement(s)
If you or your dependents are Medicare eligible please send a copy of your Medicare card(s)
Marital Status:
Married Single (Never Married) Divorced Separated
Divorced & Remarried Widow (Date of Death) ______________ Other ______________
CURRENT SPOUSE
Name: ________________________________________ SSN: ______________________________________________
Date of Birth: ___________________________________ Date of Marriage: ____________________________________
FORMER SPOUSE If NO former spouse(s), check here
Name: _________________________________________________ Date of Marriage: ___________________________
Date of Separation: _____________________________
If more than one divorce, please attach additional sheet listing all former spouses. If former spouse or current spouse is
deceased, please provide copy of the Death Certificate.
Application for Retirement
3
Name: _________________________________ CFAO ID #, UBC#, or SSN: __________________
Type of Pension Requested*:
Regular Pension: For Participants who have:
Reached age 62 and have attained 10 years of Eligibility Credit or 10 years
of Vesting Credit
Reached age 65 and have attained 5 years of Eligibility Credit or 5 years of
Vesting Credit
Service Pension: For Participants who have:
Attained 30 Northern California Eligibility Credits
Please Note: Credit worked in related/other plans may apply toward a
Service Pension. Please see page 5 for a list of related/other plans.
Early Pension: For Participants who have:
Reached age 55-61 with at least 10 Years of Eligibility Credit
Your benefit values will be reduced by ½ of 1% every month you are younger
than 62
Disability Pension: For Participants who:
Are younger than age 62 with at least 10 Years of Eligibility Credit
Have been Awarded Total Disability with the Social Security Administration
Has earned at least three-twelfths of Eligibility Credit in the 5 consecutive
Calendar Years prior to the Calendar year you became permanently and
totally disabled.
NOTE: A retro Disability effective date is ONLY available if a copy of your
Disability award letter is submitted within 90 days of the issue date.
Reciprocal Pension: For Participants who:
Would be eligible for a Regular, Early Retirement, or Disability Pension
with your credit earned under a related plan treated as Northern California
Credit.
*PLEASE NOTE: A Permanent Break in Service can affect vesting status of any pension type.
Start Date of Carpenters Pension: ___________________________________________________________________
Month/Year
Your date of retirement will be no sooner than the first of the month after your application has been received in the Fund
Office (with the exception of a qualifying Disability Pension).
Date of Last Employment: _______________________________ (IRS “Separation of Service” rules apply, see page 7.)
Month Day Year
Name of most recent employer, whether in the Industry or not: _______________________________________________
Was your last Employer’s nature of business in the Building and Construction Industry? YES NO
(For a definition of the “Building and Construction Industry,” see page 7.)
4
Pension Fund
Name: _________________________________CFAO ID #, UBC#, or SSN: ___________________
PLEASE NOTE: If you are applying for an Early, Disability, or Service Pension, Employment records are required for
any years in which we have less than 1200 hours starting on and after July 1, 1991. Please provide one of the below
listed options for the years required, failure to provide necessary documents will delay processing.
IRS 1040 and W-2 forms (include Schedule C & E of tax document, if applicable)
Social Security Detailed Earnings Information Report from Social Security Administration, this report must have a
stamp of origin to be accepted (See Form SSA-7050-F4 at ssa.gov)
If you are applying for a DISABILITY pension:
Submit a copy of your Social Security Disability Award and answer the questions below.
1. Date you became Disabled__________________________________
Month Day Year
2. Since the date you became disabled, have you engaged in any employment?
Yes No If “yes”, explain______________________________________________
PLEASE NOTE: We can only process a Disability Pension once a valid Social Security Disability Award letter is
provided. If you have not yet applied or are still in the process of applying, your application will be denied.
FUTURE SERVICE ELIGIBILITY CREDITS FOR NON-WORKING TIME
Eligible participants may receive credit for non-working temporary disability, please review below
1. Are you currently receiving Temporary Disability through
California State Disability Insurance (SDI)?
Workers’ Compensation?
No, I am NOT currently in receipt of Temporary Disability.
2. Did you previously receive Temporary Disability through
California State Disability Insurance (SDI)?
Workers’ Compensation?
Longshoremen’s and Harbor Worker’s Compensation Act?
No, I previously did NOT receive temporary disability.
3. Please list the dates of disability, if applicable
From______________________ To_____________________ From_________________ To_______________
Month/Day/Year Month/Day/Year Month/Day/Year Month/Day/Year
From______________________ To_____________________ From_________________ To_______________
Month/Day/Year Month/Day/Year Month/Day/Year Month/Day/Year
Proof Documents
Unless already on record, please provide proof of payment of Temporary SDI benefits or a copy of a
letter from Workers’ Compensation.
In the event you have been paid Workers’ Compensation AND SDI, provide a copy of a Workers’
Compensation letter AND a payment history.
If your Workers’ Compensation Temporary Disability payments are still in process we will have to
deduct the Workers’ Compensation payment from your Pension payments.
Application for Retirement
5
Name: _________________________________CFAO ID #, UBC#, or SSN: ___________________
The following questions help us determine your benefits. Please review and complete.
QUALIFIED MILITARY SERVICE: Under the Services Employment and Reemployment Rights Act of1994 (USERRA).
(See page 7 for further information.)
Did you serve in the Armed Forces of the United States? Yes No
If “Yes”, Branch of Service_____________________ From ___________________To_____________________
Please submit a copy of your Form DD214
If you were a prisoner of war, please include proof documents.
APPRENTICESHIP: If you feel there are Apprenticeship hours that you have not been credited for please send in a
separate paper giving the name of employer, the address, dates of Employment and job duties.
PENSION FUNDS: List below (if any) names, dates, and locations of any other Pension Funds in whose jurisdiction you
have worked.
Fund Name _______________________________________________________________________________________
City/State ___________________________Dates of Membership____________________________________________
Fund Name _______________________________________________________________________________________
City/State ___________________________Dates of Membership____________________________________________
Fund Name _______________________________________________________________________________________
City/State ___________________________Dates of Membership____________________________________________
NON-COVERED EMPLOYMENT: If applying for an EARLY, DISABILITY or SERVICE Pension, please list below (if any)
names, dates and location of any Non-Covered Employers you worked for on or after July 1, 1991.
Name of Employer ________________________________Address___________________________________________
Dates Employed ____________________________________Job Title/Job Duties_______________________________
Name of Employer ________________________________Address___________________________________________
Dates Employed ______________________Job Title/Job Duties_____________________________________________
RELATED/SPECIAL PLANS: If you worked for one of the below captioned plans please mark the appropriate box(es).
Industrial Carpenters Marine Carpenters International Carpenters
Carpenters International Staff Pension Plan Southern California Carpenters Pension Pan
Lathers 109 Base Plan Pension Plan Employer that had a Memorandum of Understanding on file
6
Pension Fund
Name: _________________________________CFAO ID #, UBC#, or SSN: ___________________
INDIVIDUAL STATEMENT
I hereby apply for a Pension from the Carpenters Pension Trust Fund for Northern California.
I certify under Penalty of perjury that all of the above statements are complete, true and correct, and that this application
was signed by me in the County of _________________________________________________
in the State of________________________________________________ on the date indicated below.
I have read and understand this entire 16 page application, including Reference Material (“Explanation of Benefit Payment
Options,” “Relative Value Participant Disclosure,” and the “Notice Regarding [my] Right to Defer Pension Payment”)
included in this application.
I understand that a false statement may disqualify me from my pension benefits, and that the Board of Trustees shall have
the right to recover any payments made to me because of a false statement.
My signature, which appears below, will be used at all times in endorsing the Pension checks that you send to me.
________________________________________________ __________________________________
Print Name CFAO ID #, SSN, or UBC
________________________________________________ _________________________________
Participant’s Signature Date
REVIEW
PROCESSING TIMELINE: 60-90 DAYS
BE SURE TO SIGN AND DATE THE APPLICATION.
PLEASE NOTE: THE PENSION PROCESS IS A TWO STEP PROCESS.
A SECOND PACKET IS SENT AFTER REVIEW TO FINALIZE CERTAIN PENSION OPTIONS.
CHECKLIST OF ITEMS TO SUBMIT
Completed Application
Certified Marriage Certificate
Certified Birth Certificate
Certified Birth Certificate for Spouse
Copy of any/all previous divorce decrees and Marital Settlement Agreements
Medicare card(s) for yourself and any dependent(s) that are eligible for Medicare
Any required employment records if applying for Disability, Early or Service Pension (See Application for further
details.)
If applying for a Disability Pension Social Security Disability Entitlement Award Letter that indicates you are Totally and
Permanently Disabled.
Reset Form
Application for Retirement
7
REFERENCE MATERIAL
Building and Construction Industry means all building construction and all heavy highway and engineering
construction, including but not limited to the construction, erection, alteration, repair, modification, demolition, addition or
improvement in whole or in part of any building, structure, street,(including sidewalk, curb and gutter) highway, bridge,
viaduct, railroad, tunnel, airport, water supply, irrigation, flood control and drainage system, sewer and sanitation project,
dam, powerhouse, refinery, aqueduct, canal, river and harbor project, wharf, deck, breakwater, jetty, quarrying of
breakwater or riprap stone, or any other operation incidental to such construction work, including renovation work,
maintenance work, mill cabinet or furniture manufacturing or repair work or installation of any modular systems or any
other premanufactured materials performed for any public or private employer.
The term “Building and Construction” is broadly defined and may include work performed outside of Northern California
and/or outside the jurisdiction of the United Brotherhood of Carpenters and Joiners of America. The definition includes any
work incidental to construction and may include work performed in any capacity for an entity who is engaged in
construction.
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA)
A Participant’s qualified military or other uniformed service period under the Uniformed Services Employment and
Reemployment Rights Act of 1994, (USERRA), 38 USC Chapter 43. The term “qualified military or other uniformed
service” means service in the Armed Services (including the Coast Guard), Army National Guard and Air National Guard
when engaged in active duty for training, inactive duty training, or full-time National Guard duty, the commissioned corps
of the Public Health Service, and any other category of persons designated by the President in time of war or emergency
or any other persons covered under the applicable regulations.
IRS Separation of Service
Under IRS Rules, a termination must be “bona fide” in order for a Participant to qualify for a retirement distribution. A
“bona fide Separation from Service” generally means that there is a legitimate intent to Retire. An understanding that the
Participant will return to work shortly after the termination in order to facilitate a distribution of “retirement” funds not
otherwise available is not a “bona fide” retirement.
Electronic Delivery of Plan Correspondence
Electronic materials are emailed, typically in Portable Document Format (PDF), and are identical to the paper versions
you’ve been receiving. There is no charge for accepting materials online. You will need an internet connection and a
computer with an operating system capable of receiving, accessing and displaying and either printing or storing the
electronic documents received. You should have Adobe Reader to access PDF files. Learn more and download Adobe
Reader directly from Adobe’s web site, www.adobe.com. Change your email address at any time by contacting the Fund
Office at benefitservices@carpenterfunds.com, (510) 633-0333, or Toll-Free (888) 547-2054. The change must be in
writing, with your signature.
Some examples of documents that may be sent electronically include: Summary Plan Descriptions, Notice of Plan
changes, Explanation of Benefits, Benefit and Claim Department letters, Prohibited Employment Committee letters, and
Fund Trustee memorandums.
Your consent to electronic delivery of Plan documents is valid unless and until you withdraw your consent. You can
withdraw your consent and reset your preference to mail at any time by contacting the Fund Office at
benefitservices@carpenterfunds.com, (510) 633-0333, or Toll-Free (888) 547-2054. The change must be in writing, with
your signature. While e-Delivery may significantly reduce the amount of mail we send you, certain documents and service-
related correspondence will continue to be sent via U.S. Mail. Additionally, you may request a paper copy of any
documents received electronically. Unless otherwise instructed, your email address will be shared with the Carpenters
Union, Apprenticeship Training Committee and the Carpenters Trust Funds.
Providing your email address on page 2 for the receipt of mandatory disclosures is voluntary. If you provide your email
address, mandatory disclosures will be sent via email.
8
Pension Fund
EXPLANATION OF BENEFIT PAYMENT OPTIONS
You have a choice regarding how you want to receive
your pension under the different benefit payment options
offered by the Plan. If your application is approved you
will receive a Benefit Election Form outlining the specific
payment options available to you. Each option will
provide you with a monthly benefit for your lifetime.
Some benefit payment options will provide different
amounts of survivor benefits to your surviving Spouse or
named Beneficiary. The benefit payment option you
choose will affect the monthly benefit amount payable to
you while you are alive.
Choosing a benefit payment option is a personal
decision based on your particular circumstances. No
particular benefit payment option is right for everyone.
While the Fund Office staff can answer your questions
and explain how the benefit payment options work, they
cannot provide you with advice on which benefit
payment option you should choose. You may want to
consult a financial advisor when you make this important
decision.
In the pages that follow, we have attempted to provide
you with an explanation of each available payment form
and have included examples.
Option 1—50% Joint and Survivor Pension
2
Option 2—75% Joint and Survivor Pension
3
Option 3—100% Joint and Survivor Pension
3
Option 4—Single Life Pension with the 36 or
60 Month Guarantee of Benefits
4
Based on your ages when your benefit payments
start, your actual benefit amounts will vary
depending on how long you and your Spouse are
expected to live.
Upon your written request, the Fund Office can give you
a personalized explanation of each benefit payment
option based on your own age and estimated benefit
amount
.
Option 1—50% Joint and Survivor Pension
Unless waived by you and your Spouse, the 50% Joint
and Survivor Pension is the automatic form of payment
you will receive if you are legally married on your
Pension Effective Date. This form of payment provides
pension benefits to you for your lifetime, and upon your
death 50% of the amount that you were receiving
continues to your surviving Spouse for his/her lifetime.
Since benefits are guaranteed for two lifetimes, the 50%
Joint and Survivor Pension amount is reduced from the
full amount of your pension that you would otherwise
receive.
What will be the amount of my 50% Joint and
Survivor Pension?
The amount of your 50% Joint and Survivor Pension is
determined by multiplying the full amount of your
pension by a percentage. The percentage is based on
your age, the age of your Spouse on the effective date of
your pension, and the type of pension you will be
receiving.
Table 1
shows a
SAMPLE
of the percentage factors
applicable to the 50% Joint and Survivor Pension:
TABLE 1
Age of Spouse
in Relation to
Age of
Participant
Percentage of
Regular, Early or
Service Pension
Payable to
Participant
Percentage of
Disability
Pension
Payable to
Participant
5 years
younger
82%
67%
Same age
85%
70%
5 years older
88%
73%
Application for Retirement
9
Table 2
shows how a Regular Pension of $1,000.00 per
month would be adjusted for the 50% Joint and Survivor
Pension:
TABLE 2
Spouse’s
Age in
Relation to
Age of
Participant
50% Joint
and
Survivor
Factor
Pension
Payable
While Both
Pensioner
and
Spouse are
Alive
Pension to
Surviving
Spouse after
Pensioner’s
Death
Pension to
Pensioner
after
Spouse’s
Death
5 years
younger
82%
$820.00
$410.00
$1,000.00
Same
85%
$850.00
$425.00
$1,000.00
5 years
older
88%
$880.00
$440.00
$1,000.00
Additional Conditions:
 If your Spouse dies before you do, the 50% Joint
and Survivor Pension reverts to the full unreduced
amount effective as of the first of the month following
the Fund’s receipt of your Spouse’s certified death
certificate.
 If you are divorced after your pension becomes
payable, the monthly amount of the 50% Joint and
Survivor Pension will remain payable to your former
Spouse, provided your former Spouse retains rights
to any spousal benefits under the terms of a
Qualified Domestic Relations Order.
 If you elect the 50% Joint and Survivor Pension, the
other payment options described here will not apply.
The 50% Joint and Survivor Pension will not be paid
if:
 You and your Spouse were not lawfully married to
each other on your Pension Effective Date and
throughout a 12-month period prior to your date of
death (a marriage to the same Spouse that
terminated prior to your Pension Effective Date will
not count when determining if this 12-month rule is
satisfied); or
 Your Spouse dies before your Pension payments
begin; or
 Your marriage was legally terminated before your
Pension began, unless a Qualified Domestic
Relations Order provides that your Spouse is to be
treated as the surviving Spouse for the purpose of
the 50% Joint and Survivor Pension.
Option 2—75% Joint and Survivor Pension
The 50% Joint and Survivor Pension (as previously
described on page 2) is the automatic form of payment
you will receive if you are lawfully married on your
Pension Effective Date. If you waive the 50% Joint and
Survivor Pension, you may elect the 75% Joint and
Survivor Pension. This form of payment provides
pension benefits to you for your lifetime, and upon your
death 75% of the amount that you were receiving
continues to your surviving Spouse for his/her lifetime.
Since benefits are guaranteed for two lifetimes, the 75%
Joint and Survivor Pension amount is reduced from the
full amount of your pension that you would otherwise
receive.
What will be the amount of my 75% Joint and
Survivor Pension?
The amount of your 75% Joint and Survivor Pension is
determined by multiplying the full amount of your
pension by a percentage. The percentage is based on
your age, the age of your Spouse on the effective date of
your pension, and the type of pension you will be
receiving.
Table 1
shows a
SAMPLE
of the percentage factors
applicable to the 75% Joint and Survivor Pension:
TABLE 1
Age of Spouse
in Relation to
Age of
Participant
Percentage of
Regular, Early or
Service Pension
Payable to
Participant
Percentage
of Disability
Pension
Payable to
Participant
5 years younger
77%
60%
Same age
80%
62%
5 years older
83%
64%
10
Pension Fund
Table 2
shows how a Regular Pension of $1,000.00 per
month would be adjusted for the 75% Joint and Survivor
Pension:
TABLE 2
Spouse’s Age
in Relation to
Age of
Participant
75%
Joint
and
Survivor
Factor
Pension
Payable
While Both
Pensioner
and
Spouse are
Alive
Pension to
Surviving
Spouse after
Pensioner’s
Death
Pension to
Pensioner
after
Spouse’s
Death
5 years
younger
77%
$770.00
$577.50
$1,000.00
Same
80%
$800.00
$600.00
$1,000.00
5 years
older
83%
$830.00
$622.50
$1,000.00
Additional Conditions:
 If your Spouse dies before you do, the 75% Joint
and Survivor Pension reverts to the full unreduced
amount effective as of the first of the month following
the Fund’s receipt of your Spouse’s certified death
certificate.
 If you are divorced after your pension becomes
payable, the monthly amount of the 75% Joint and
Survivor Pension will remain payable to your former
Spouse, provided your former Spouse retains rights
to any spousal benefits under the terms of a
Qualified Domestic Relations Order.
 If you elect the 75% Joint and Survivor Pension, the
other payment options described here will not apply.
 The 75% Joint and Survivor Pension is not available
as a Pre-Retirement Death Benefit.
The 75% Joint and Survivor Pension will not be paid
if:
 You and your Spouse were not lawfully married to
each other on your Pension Effective Date and
throughout a 12-month period prior to your date of
death (a marriage to the same Spouse that
terminated prior to your Pension Effective Date will
not count when determining if this 12-month rule is
satisfied); or
 Your Spouse dies before your Pension payments
begin; or
 Your marriage was legally terminated before your
Pension began, unless a Qualified Domestic
Relations Order provides that your Spouse is to be
treated as the surviving Spouse for the purpose of
the 75% Joint and Survivor Pension.
Option 3—100% Joint and Survivor Pension
The 50% Joint and Survivor Pension (as previously
described on page 2) is the automatic form of payment
that you will receive if you are legally married on your
Pension Effective Date. If you waive the 50% Joint and
Survivor Pension, then you may elect the 100% Joint
and Survivor Pension. This form of payment provides
pension benefits to you for your lifetime, and upon your
death 100% of the amount you were receiving continues
to your surviving Spouse for his/her lifetime. Since
benefits are guaranteed for two lifetimes, the 100% Joint
and Survivor Pension amount is reduced from the full
amount of your pension that you would otherwise
receive.
What will be the amount of my 100% Joint and
Survivor Pension?
The amount of your 100% Joint and Survivor Pension is
determined by multiplying the full amount of your
pension by a percentage. The percentage is based on
your age, the age of your Spouse on the effective date of
your pension, and the type of pension you will be
receiving.
Table 1
shows a
SAMPLE
of the percentage factors
applicable to the 100% Joint and Survivor Pension:
TABLE 1
Age of Spouse
in Relation to
Age of
Participant
Percentage of
Regular, Early or
Service Pension
Payable to
Participant
Percentage of
Disability
Pension
Payable to
Participant
5 years younger
72%
54%
Same age
75%
56%
5 years older
78%
58%
Application for Retirement
11
Table 2
shows how a Regular Pension of $1,000.00 per
month would be adjusted for the 100% Joint and
Survivor Pension:
TABLE 2
Spouse’s
Age in
Relation to
Age of
Participant
100%
Joint and
Survivor
Factor
Pension
Payable
While Both
Pensioner
and
Spouse are
Alive
Pension to
Surviving
Spouse after
Pensioner’s
Death
Pension to
Pensioner
after
Spouse’s
Death
5 years
younger
72%
$720.00
$720.00
$1,000.00
Same
75%
$750.00
$750.00
$1,000.00
5 years
older
78%
$780.00
$780.00
$1,000.00
Additional Conditions:
 If your Spouse dies before you do, the 100% Joint
and Survivor Pension reverts to the full unreduced
amount effective as of the first of the month following
the Fund’s receipt of your Spouse’s certified death
certificate.
 If you are divorced after your pension becomes
payable, the monthly amount of the 100% Joint and
Survivor Pension will remain payable to your former
Spouse, provided your former Spouse retains rights
to any spousal benefits under the terms of a
Qualified Domestic Relations Order.
 If you elect the 100% Joint and Survivor Pension,
the other payment options described here will not
apply.
 The 100% Joint and Survivor Option is not available
as a Pre-Retirement Death Benefit.
The 100% Joint and Survivor Pension will not be
paid if:
 You and your Spouse were not lawfully married to
each other on your Pension Effective Date and
throughout a 12-month period prior to your date of
death (a marriage to the same Spouse that
terminated prior to your Pension Effective Date will
not count when determining if this 12-month rule is
satisfied); or
 Your Spouse dies before your Pension payments
begin; or
 Your marriage was legally terminated before your
Pension began, unless a Qualified Domestic
Relations Order provides that your Spouse is to be
treated as the surviving Spouse for the purpose of
the 100% Joint and Survivor Pension.
Option 4— Single Life Pension with the 36 or 60
month Guarantee of Benefits
The Single Life Pension with the 36 or 60 month
Guarantee of Benefits is the automatic form of payment
you will receive if you are single on your Pension
Effective Date. It is also available if you are married,
provided that both you and your Spouse reject the 50%
Joint and Survivor Pension (as previously described on
page 2).
What will be the amount of my Single Life Pension
with the 36 or 60 month Guarantee of Benefits?
The amount of your Single Life Pension with the 36 or 60
month Guarantee of Benefits is the full amount of your
Regular, Early Retirement, Service, or Reciprocal
Pension.
The Single Life Pension with the 36 or 60 month
Guarantee of Benefits provides pension benefits to you
for your lifetime.
If you die prior
to receiving 60 monthly
payments (36 monthly payments if you are on a
Disability Pension), the remaining payments will be
payable to your surviving Spouse or named Beneficiary.
If you die after receiving 60 monthly payments (36
monthly payments if you are on a Disability Pension), no
further pension benefits will be payable to your surviving
Spouse or named Beneficiary.
Please note:
The sample percentage factors and benefit
amounts shown on the previous pages are not a
guarantee or even a prediction of what you will
actually receive after you retire. You should not
rely upon them as though they are.
Based on your ages when your benefit payments
start, your actual benefit amounts will vary
depending on how long you and your surviving
Spouse are expected to live.
This is not the only information you should take
into account when choosing your benefit payment
option for retirement. Other factors you might want
to take into account when deciding which benefit
12
Pension Fund
payment option to choose include your health,
other sources of retirement income, other
resources available to your Spouse or family after
your death, availability of life insurance, etc. You
may want to consult a financial advisor when you
make this important decision.
Upon your written request, the Fund Office can give
you a personalized explanation of each benefit
payment option based on your own age and
estimated benefit amount.
Table 1
shows a
SAMPLE
of the percentage factors
applicable to the 100% Joint and Survivor Pension:
TABLE 1
Age of Spouse
in Relation to
Age of
Participant
Percentage of
Regular, Early or
Service Pension
Payable to
Participant
Percentage of
Disability
Pension
Payable to
Participant
5 years younger
72%
54%
Same age
75%
56%
5 years older
78%
58%
Table 2
shows how a Regular Pension of $1,000.00 per
month would be adjusted for the 100% Joint and
Survivor Pension:
TABLE 2
Spouse’s
Age in
Relation to
Age of
Participant
100%
Joint and
Survivor
Factor
Pension
Payable
While Both
Pensioner
and
Spouse are
Alive
Pension to
Surviving
Spouse after
Pensioner’s
Death
Pension to
Pensioner
after
Spouse’s
Death
5 years
younger
72%
$720.00
$720.00
$1,000.00
Same
75%
$750.00
$750.00
$1,000.00
5 years
older
78%
$780.00
$780.00
$1,000.00
Additional Conditions:
 If your Spouse dies before you do, the 100% Joint
and Survivor Pension reverts to the full unreduced
amount effective as of the first of the month following
the Fund’s receipt of your Spouse’s certified death
certificate.
 If you are divorced after your pension becomes
payable, the monthly amount of the 100% Joint and
Survivor Pension will remain payable to your former
Spouse, provided your former Spouse retains rights
to any spousal benefits under the terms of a
Qualified Domestic Relations Order.
 If you elect the 100% Joint and Survivor Pension,
the other payment options described here will not
apply.
 The 100% Joint and Survivor Option is not available
as a Pre-Retirement Death Benefit.
The 100% Joint and Survivor Pension will not be
paid if:
 You and your Spouse were not lawfully married to
each other on your Pension Effective Date and
throughout a 12-month period prior to your date of
death (a marriage to the same Spouse that
terminated prior to your Pension Effective Date will
not count when determining if this 12-month rule is
satisfied); or
 Your Spouse dies before your Pension payments
begin; or
 Your marriage was legally terminated before your
Pension began, unless a Qualified Domestic
Relations Order provides that your Spouse is to be
treated as the surviving Spouse for the purpose of
the 100% Joint and Survivor Pension.
Option 4— Single Life Pension with the 36 or 60
month Guarantee of Benefits
The Single Life Pension with the 36 or 60 month
Guarantee of Benefits is the automatic form of payment
you will receive if you are single on your Pension
Effective Date. It is also available if you are married,
provided that both you and your Spouse reject the 50%
Joint and Survivor Pension (as previously described on
page 2).
What will be the amount of my Single Life Pension
with the 36 or 60 month Guarantee of Benefits?
The amount of your Single Life Pension with the 36 or 60
month Guarantee of Benefits is the full amount of your
Regular, Early Retirement, Service, or Reciprocal
Pension.
The Single Life Pension with the 36 or 60 month
Guarantee of Benefits provides pension benefits to you
Application for Retirement
13
for your lifetime.
If you die prior
to receiving 60 monthly
payments (36 monthly payments if you are on a
Disability Pension), the remaining payments will be
payable to your surviving Spouse or named Beneficiary.
If you die after receiving 60 monthly payments (36
monthly payments if you are on a
Disability Pension), no
further pension benefits will be payable to your surviving
Spouse or named Beneficiary.
Please note:
The sample percentage factors and benefit
amounts shown on the previous pages are not a
guarantee or even a prediction of what you will
actually receive after you retire. You should not
rely upon them as though they are.
Based on your ages when your benefit payments
start, your actual benefit amounts will vary
depending on how long you and your surviving
Spouse are expected to live.
This is not the only information you should take
into account when choosing your benefit payment
option for retirement. Other factors you might want
to take into account when deciding which benefit
payment option to choose include your health,
other sources of retirement income, other
resources available to your Spouse or family after
your death, availability of life insurance, etc. You
may want to consult a financial advisor when you
make this important decision.
Upon your written request, the Fund Office can give
you a personalized explanation of each benefit
payment option based on your own age and
estimated benefit amount.
RELATIVE VALUE PARTICIPANT DISCLOSURE
IRS regulations require plans such as ours to give
retiring Participants a comparison of the relative values
of the benefit payment options generally available under
the Plan. The aim is to help you make an informed
choice about the form in which you receive your
retirement benefits. “Relative value” means the actuarial
present value of each optional form of payment as
compared to the 50% Joint and Survivor Pension Benefit
(also called the “QJSA”), or, for unmarried Participants,
as compared to the Single Life Pension. If the relative
value of the optional form falls within IRS prescribed
parameters, it may be described as “approximately
equal” to the QJSA or the Single Life Pension. In the
accompanying chart, “AE” stands for “approximately
equal.”
The following tables show the relative values of the
benefit payment options available to retiring Participants.
As you can see, for many Participants, all optional
payment forms have approximately the same actuarial
value if the Participant and Spouse are the same age.
However, for married disabled participants the relative
value of the 75% and 100% Joint and Survivor Pensions
are of lower value at certain ages. These conclusions
are based on the valuation and reporting methodologies
described in the IRS regulation, which can be found at
Treas. Reg. Section 1.417(a)(3)-1. Upon your written
request, we will provide you with a similar comparison
based on your own age and estimated benefits, and on
any other payment forms for which you are eligible.
The relative values are based on comparing the actuarial
values of the benefit payment options to the actuarial
value of the QJSA. Actuarial values of pension benefits
are determined using mortality and interest assumptions.
Mortality assumptions are based on standardized tables
developed by actuarial organizations and life insurance
companies, which analyze information about large
groups of people to project the rates at which groups of
individuals at different ages are expected to die. These
statistical mortality projections are used to develop
“average life expectancies.” The interest assumption is
an estimate of the likely investment earnings, over time,
on the money put aside to pay the benefits. This is
relevant in the determination of actuarial values because
investment earnings will provide some of the funds to
pay the benefits.
Here the values were calculated assuming the funds
would earn 5.0% interest and that, on average,
Participants would live as long as predicted under the
PBGC Mortality Table for males, or the PBGC Mortality
Table for disabled males set forward 5 years for
Participants retiring on a Disability Pension. In addition,
we assumed beneficiaries would live as long as
predicted under the PBGC Table for females, and that
the Spouse is the same age as the Participant.
For all unmarried Participants retiring from the Plan, all
available options are approximately equal in value as the
normal form of payment if the Participant and Spouse
are the same age.
14
Pension Fund
Chart for Married Participants Not Retiring on a
Disability Pension
Age
QJSA
50% Joint
and
Survivor
Single Life
with 36-
Month
Guarantee
75%
Joint and
Survivor
100%
Joint and
Survivor
55
100%
AE*
AE
AE
60
100%
AE
AE
AE
65
100%
AE
AE
AE
*AE means approximately equal in value.
Chart for Married Participants Retiring on a Disability
Pension
Age
QJSA
50% Joint
and
Survivor
Single Life
with 36-
Month
Guarantee
75%
Joint and
Survivor
100% Joint
and
Survivor
35
100%
AE*
92.71%
87.44%
40
100%
AE
93.65%
89.13%
45
100%
AE
94.73%
91.08%
50
100%
AE
AE
93.30%
55
100%
AE
AE
AE
*AE means approximately equal in value.
For married Participants retiring on a Disability Pension,
the actuarial present values of the 100% Joint and
Survivor Pension and the 75% Joint and Survivor
Pension are of lower value at certain ages.
It is important that you realize that this is not a guarantee
or even a prediction of what you will actually receive
after you retire. You should not rely upon it as if it were.
The actual value of a stream of annuity payments for any
individual, and its comparison to the values of different
payment forms, will vary depending on how long the
individual and Spouse or Beneficiary in fact live and on
their ages when payments start. This is not the only
information you should take into account when choosing
your payment form for retirement. Other factors you
might want to take into account in deciding how much a
particular payment option is worth to you personally, in
comparison to the other forms in which your pension can
be paid, include your health, your other sources of
retirement income, the resources available to your
Spouse or family after you die, availability of life
insurance, etc. You may want to consult a financial
advisor when you make this important decision.
To obtain an individual relative values estimate, please
send a written request to:
Carpenters Funds Administrative Office of
Northern California, Inc.
P.O. Box 2280
Oakland, CA 94614
Fax: (510) 633-0215
Email: benefitservices@carpenterfunds.com
NOTICE REGARDING YOUR RIGHT TO DEFER
PENSION PAYMENT
Please be advised that if you have not reached the
Required Beginning Date (April 1
st
of the Calendar
Year following the year you reach age 70.5) you have
the right to defer receiving your Pension. Depending on
your circumstances, your monthly Pension benefit may
be larger if you defer your retirement. First, your
monthly benefit generally will be larger if you defer
retirement and continue to work in Covered Employment
and accrue benefits. Additionally, if you retire on an
Early Retirement Pension before the age of 62, your
monthly benefit is reduced to reflect the longer period of
time that you will be collecting payments. Therefore, if
you delay retiring until an age closer to age 62, the
reduction in your monthly benefit will be smaller.  Please
note that your benefit will not be increased for any delay
from age 62 to age 65. Finally, as described below, you
may be entitled to an actuarial increase in benefits for
each complete calendar month you delay retirement
beyond age 65 (or Normal Retirement Age, if later) and
do not work in Prohibited Employment in the 46 Northern
California Counties.
Early Retirement Reduction
Your Early Retirement Pension will be your Regular
Pension amount reduced by ½ of 1% for each month
you are younger than age 62 on the effective date of
your Early Retirement Pension.
For example
: John
decides to retire on an Early Retirement Pension at 58.
If he were 62 his Regular Pension benefit would be
$1,000. Since John is 48 months younger than age 62
his reduction is ½ of 1% for each of the 48 months,
which equals 24%. The reduction is therefore 24% of
1,000 or $240. John’s lifetime monthly benefit is
Application for Retirement
15
therefore $760 ($1000-$240). Please refer to the Plan
Section 3.05. “Amount of the Early Retirement Pension.”
Delayed Retirement
You may be entitled to an actuarial increase in benefits
for each complete calendar month you delay retirement
beyond age 65 (or Normal Retirement Age, if later) and
do not work in Prohibited Employment
in the 46
Northern California Counties. In order for this office to
make a determination you will need to provide either
your IRS 1040 and W-2 forms, or a Detailed Earnings
Sttement form the Social Security Office that lists your
employers names from the date of your Normal
Returement Age (typically age 65 through your
Retirement effective date.
Prohibited Employment is employment, either covered or
non-covered, for wages or profit in the Building and
Construction Industry.
For
Example:
John has earned
a Normal Retirement Benefit of $1,000. At age 65, John
ceases working in Prohibited Employment. Here is the
lifetime monthly benefit John would receive if he chose
to retire between the ages of 65 and 70. Please refer to
Plan Section 10.09. “Actuarial Adjustment for Delayed
Retirement.”
 
John’s
Age at
Retirement
65
66
67
68
69
70
John’s
Monthly
Benefit
$1,000
$1,090
$1,180
$1,270
$1,360
$1,450
Please contact the Fund Office to get an estimate of
how much larger your benefit will be if you defer
your retirement.
(Toll Free: (888) 547-2054, Direct Dial:
(510) 633-0333, email:
benefitservices@carpenterfunds.com)
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