Pension Application Package

American Federation of Musicians & Employers’ Pension Fund
Dear Plan Participant:
This application packet contains the following items needed to begin the two-part application process:
1. Part 1: Preliminary Information Form - Please read the instructions carefully before completing Part 1. Acceptable proof of age document types are detailed on the last page of the form. Mail the completed Part 1 with all required documents to the Fund Office at: American Federation of Musicians and Employers’ Pension Fund PO Box 2673 New York, NY 10117-0262 Attn: Pension Claims
2. Applying for Your Pension Benefit – The Two-Part Application – provides you with a description of the two parts in the application process and an explanation of how your Pension Effective Date will be determined,
3. Early Retirement Quick Guide - The Quick Guide is a user-friendly reference for the Early Retirement Procedures - Participant Notice (see below). While it does not replace the Notice, we wanted to give you this guide to address some of the recurring questions we receive concerning the Procedures.
4. Early Retirement Procedures - Participant Notice – details the Fund’s rules for determining whether a participant has retired, is eligible to begin receiving an early retirement pension and continues to be eligible at the later testing date(s). These procedures are applicable to a participant who is younger than Normal Retirement Age (generally age 65) at his/her Pension Effective Date, and
5. Notice for Foreign Resident Payee – U.S. Federal Income Tax Withholding – provides details of the U.S. Internal Revenue Service requirements for withholding and documentation for Non Resident Aliens and U.S. persons receiving benefit payments and living in a foreign country.
The Fund Office will acknowledge receipt of Part 1. If additional information and/or documents are required to complete Part 1 or if you are not eligible of a pension benefit, you will be notified.
If you have any questions or require assistance completing Part 1: Preliminary Information Form, please call 212-284-1200 and press 2 to be connected to the Pension Department.
1.1.2.08262020

www.afm-epf.org
American Federation of Musicians & Employers’ Pension Fund
PENSION APPLICATION PART 1: PRELIMINARY INFORMATION FORM - WEBSITE
INSTRUCTIONS
• Part 1 is a fillable form which allows you to enter the information requested into appropriate spaces. Please answer questions 1 – 15 completely and accurately.
• Print your completed Part 1, make sure to sign and date it on page 5, and mail it with all required documents to the Fund Office:
American Federation of Musicians and Employers’ Pension Fund PO Box 2673, New York, NY 10117-0262 Attention: Pension Claims • To avoid processing delays, include all required documents requested, such as, proof of age, marriage and divorce documents. As soon as administratively possible after the Fund’s receipt of a complete Part 1, including any additional items that we may need to complete this step of the application process, we will send you Part 2 of the application, which allows you to choose how your pension benefit will be paid. We will also let you know your earliest Pension Effective Date (as defined in item 14). Nothing in Part 1 modifies the terms of the official Plan document in any way. The Plan document, the summary plan description, and all of the documents mentioned here are also available on the Fund’s website at www.afm-epf.org. If you have questions or require assistance in connection with Part 1 of the application, please contact the Fund Office at 1-800-833-8065 and select option 2 for the Pension Department.
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American Federation of Musicians & Employers’ Pension Fund

PENSION APPLICATION PART 1: PRELIMINARY INFORMATION FORM
Please complete all 7 sections of this form by filling in the blanks online. You must then print the form, sign where indicated and mail with all required documents to the Fund Office.

Section 1 - Your Personal Information

1. NAME_________________________________________________________________________________

Last

First

Middle

2. Other name(s) you have used while working (including any professional names, maiden name, etc.)

_____________________________________________________________________________________

3. a. MAILING ADDRESS _____________________________________________________________________

Number

Street

Apt. #

________________________________________ _ _______________ _____________________ _______________________________

City

State

Zip/Postal Code

Country

b. EMAIL ADDRESS__________________________________________________

4. PHONE NUMBER (1st #) _____________________________ (2nd #) _________________________________

Area Code

Area Code

5. SOCIAL SECURITY # _ ________________________________________________

6. DATE OF BIRTH _______________________________________________(proof required – see Section 8 on page 6)
mm/dd/yyyy

Section 2 - Your Marital Status

7. Check all that apply:
Single (never married) Widowed Divorced (even if you have re-married) Legally Separated Married*

(Required Documents) (None) (A copy of your spouse’s death certificate) (A copy of your complete divorce decree including any property settlement)
(A copy of the court order of legal separation) (Copies of your marriage certificate and your spouse’s proof of age document – see Section 8 on page 6)

*If married, please answer the questions about your spouse in Section 3 on page 2.

(Marital Status continued on page 2)

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Section 2 - Your Marital Status (Continued from page 1)

8. Is there a court order requiring the payment of a portion of your pension benefit to a former spouse or to any other

party?

Yes

No

If the answer is yes, copies of the complete court order and property settlement agreement must accompany this application.

Section 3 - Your Spouse’s Information (Complete if you checked “Married” in Section 2)

SPOUSE’S NAME ___________________________________________________________________________

Last

First

Middle

SPOUSE’S ADDRESS_ _______________________________________________________________________

Number

Street

Apt. #

________________________________________ _ _______________ _____________________ _______________________________

City

State

Zip/Postal Code

Country

SPOUSE’S PHONE NUMBER ___________________________________________________
Area Code

SOCIAL SECURITY # _ __________________________________________________

DATE OF BIRTH _ ________________________________________________(proof required – see Section 8 on page 6)
mm/dd/yyyy
DATE OF MARRIAGE______________________________________________(proof required)
mm/dd/yyyy

Section 4 - Optional Form of Benefit Payment

9. On Part 2 of the application, which will be sent to you at a later date, you may select either of the following optional forms of benefit payment: a. 50% joint and survivor benefit: you will receive reduced monthly payments during your lifetime, with half of the monthly payment you were receiving on your date of death continuing to the person you select (your “joint annuitant”) for the rest of his or her lifetime, or b. 75% joint and survivor benefit: you will receive reduced monthly payments during your lifetime, with threequarters of the monthly payment you were receiving on your date of death continuing to your joint annuitant for the rest of his or her lifetime. This payment option is available only if the age difference between you and a non-spouse joint annuitant is 19 years or less.
If you wish to consider these optional forms of benefit payment with anyone other than your spouse, please list below the name and birth date of the person you would most likely designate as your joint annuitant. We will provide you with the amount of monthly pension benefit you would receive under these options if you designate that person as your joint annuitant.

_ ___________________________________________ Name of potential joint annuitant

______________________________________

Date of Birth

mm/dd/yyyy

(proof required – see Section 8 on page 6)

Please note that any person you list above is for purposes of calculating potential benefit information only. In no circumstance

will the fact that you have listed a person as a potential joint annuitant be treated as an election to receive your pension benefit

in the form of a 50% joint and survivor benefit, a 75% joint and survivor benefit, or as a designation of your joint annuitant. Any

election of benefit payment form and designation of a joint annuitant (with written spousal consent, if applicable) must be made

in Part 2 of the application. Please be reminded, Part 2 of the application will be sent to you at a later date.

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Section 5 - AFM & EPF Information
10. Current AFM Local Union # ________________________________________________________________ If you are member of multiple AFM Locals, please enter all that apply.

11. If your work under the AFM&EPF was interrupted by a period of service in the U.S. Armed Forces, please provide the following information:

Enlistment date: ___________________________ Discharge date: _______________________________

mm/dd/yyyy

mm/dd/yyyy

Last employer prior to enlistment____________________________________________________________

First employer after discharge ______________________________________________________________ Please enclose a copy of your military discharge papers (DD214).

12. Have you ceased work under the AFM & EPF because of total disability?

Yes

No

If the answer is yes,

you want the Fund to determine your eligibility for a Disability Pension Benefit

and you do not have a Social Security Administration disability award letter, please call the Fund Office at

1-800-833-8065 extension 1311 to request an Attending Physician’s Statement claim form. Alternately, this form is

available on the Fund’s website at: http://www.afm-epf.org/Portals/2/AFMDocuments/Attending%20Physician

%20Statement.pdf

If you checked yes, please answer the following:

Date your disability began: _ ________________________________________________________
mm/dd/yyyy
Date you last worked for a contributing employer: _________________________________________
mm/dd/yyyy
Please state the instrument(s) that you played: ___________________________________________
___________________________________________
___________________________________________
___________________________________________
If you are applying for a Disability Pension Benefit, this form must be accompanied by a completed Attending Physician’s Statement claim form or your Social Security Administration disability benefit award letter.

13. Have you worked under the jurisdiction of a Canadian local of the AFM? Please answer the following:

Yes

No

Canadian Local # ______________________________________

Your Canadian Social Insurance # _ ___________________________________________________

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Section 6 - Your Requested Pension Effective Date
14. Your Pension Effective Date is the first day of the first month for which you receive your pension benefit. • Your earliest Pension Effective Date is the first day of the first month following the month in which we receive from you a complete Part 2 of the Pension Application (Choice of Benefit Payment Option form and spousal consent form, if required) if we receive these forms on or before the 15th day of the month or, if we receive the forms after the 15th day of the month, your Pension Effective Date is the first day of the second month following our receipt of the forms. • You may choose a later Pension Effective Date.
• Your Pension Effective Date will not change if there is an administrative delay in processing your benefits: in that case, you will receive retroactive benefits back to your Pension Effective Date.
Please refer to the accompanying article, Applying for Your Pension Benefit – The Two-Part Application for more information.
SPECIAL NOTE: If you will be younger than age 65 on your requested Pension Effective Date, which you will enter below, you must have retired from all employment with any employer contributing to the Fund on or before your Pension Effective Date. You will be considered to be retired only if you meet all of the following requirements:
a. You have stopped all work with all employers who contribute to the Fund as of your Pension Effective Date, whether or not pension contributions are payable for such work;
b. You have no intention or expectation to work after your Pension Effective Date with any employer who contributes to the Fund;
c. You have no right under a collective bargaining agreement or any other contractual right to employment after your Pension Effective Date with any employer who contributes to the Fund;
d. You perform no work of any kind for an employer participating in the Fund during the two calendar months immediately following your actual Pension Effective Date (which may be later than your requested Pension Effective Date below); and
e. If you retire from steady employment with an employer that has seasonal breaks in work at the end of a season, you perform no work of any kind for that employer in the first two calendar months following the beginning of that employer’s new season.
Please refer to the enclosed Early Retirement Procedures - Participant Notice for detailed information concerning the eligibility requirements, the process the Fund will use to verify your retirement, and the consequence of being treated by the Fund as having failed to retire.
Please Note – This information is required: I request the following Pension Effective Date (must be 90 or more days after the date on which you return this completed Part 1):
Month: _____________________ Year: 20 ________
If you specify a Pension Effective Date that is fewer than 90 days from the date we receive a completed Part 1, or the application process cannot be completed by the 15th of the month before your requested Pension Effective Date, your actual Pension Effective Date will be later than the date you requested. Please refer to the accompanying article, Applying for Your Pension Benefit – The TwoPart Application for an explanation how the Pension Effective Date is determined.

(Section 6 continued on page 5)

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Section 6 - Your Requested Pension Effective Date (Continued from page 4)

15. If you will be younger than age 65 on your requested Pension Effective Date in item 14 on page 4, please answer the following:

Have you worked in employment over the past twelve months where there are seasonal breaks?

Yes

No

If you answered yes, please complete the following:

Employer’s Name_______________________________________________________________________

The current season began on _ ___________________ and will end/ended on ________________________

mm/dd/yyyy

mm/dd/yyyy

The next season will begin on ______________________________
mm/dd/yyyy

Section 7 - Applicant’s Affidavit

I hereby apply to the American Federation of Musicians and Employers’ Pension Fund for a pension benefit with respect to work that I performed for one or more employers contributing to the Fund. The above statements are true to the best of my knowledge and belief, under penalty of perjury. I understand that if I make a willfully false or fraudulent statement or furnish fraudulent information or proof, benefits paid on account of my false statement will be denied or discontinued, and that the Trustees shall have the right to recover any payments made to me because of a false statement. I also understand that any false or fraudulent statement made herein may subject me to penalties under Federal and State law.

If I will be under age 65 on my requested Pension Effective Date, I acknowledge receipt of the Early Retirement Procedures - Participant Notice, and I hereby certify that, as of my Pension Effective Date, I am retiring from all employment with all employers contributing to the Fund, as described in item 14 above. I further agree to comply with the requirements for retirement as described in the Early Retirement Procedures - Participant Notice. I understand that if I do not do so, I will not be treated as having retired, and the consequences described in the Early Retirement Procedures - Participant Notice will be applicable.

______________________________ _____________________________________________

Date

mm/dd/yyyy

Signature

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Section 8 - Proof of Age
This list describes a number of documents, any one of which may be furnished as proof of age. You, your spouse, or proposed joint annuitant should submit a document as high on the list as you can, because the documents listed first are the most convincing. Photocopies are acceptable. All foreign language documents are required to be translated into English and notarized.
1. Birth certificate. 2. Baptismal certificate, or church record showing date of birth certified by the custodian. 3. Notification of registration of birth in a public registry of vital statistics. 4. Certification of record of age by the U.S. Census Bureau. 5. Hospital birth record, certified by the custodian. 6. A foreign government record of birth or age. 7. Signed statement by the physician or midwife who attended the birth, as to the date of birth
shown on their records. 8. Naturalization record. 9. Immigration papers. 10. Military record. 11. Passport. 12. School record, certified by the custodian of the record. 13. Vaccination record, certified by the custodian of the record. 14. An insurance policy, which shows, ages or dates of birth. 15. Marriage certificate, or application for marriage license or church record certified by the
custodian. 16. Other evidence, such as signed statements from persons who have knowledge of the date
of birth, or voting records.

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American Federation of Musicians & Employers’ Pension Fund
Applying for Your Pension Benefit1 The Two-Part Application
In order to receive your pension benefit, you must file a complete two-part Pension Application, and submit all required supporting documents, within the required time periods. Your failure to file a complete Pension Application will be deemed to be an election to defer payment of your benefit.
Part 1: Preliminary Information form
Part 1 of the Pension Application consists of the Preliminary Information form, along with a notice describing the Plan’s early retirement procedures. Part 1 of the Pension Application is available from the Fund Office or in the Applications and Forms section on the Fund’s website at www.afm-epf.org.
You must complete the Preliminary Information form and return it to the Fund Office, along with all required documents described in the Preliminary Information form (for example, proof of age, marriage, and divorce documents), at least 90 days before the date that you request as your Pension Effective Date on the Preliminary Information form. The Fund Office must have the required documents to verify your age, your marital status, the age of your Spouse, if applicable, and, if you are divorced, determine whether your former Spouse is entitled to any portion of your pension benefit. If you do not have your birth certificate or marriage certificate, you may be able to request them from the office of vital statistics in the state where you were born or married. If you do not have your divorce decree or divorce settlement agreement, you may be able to obtain them from the court that granted your divorce.
If you do not return a completed Preliminary Information form and all required documents at least 90 days before the Pension Effective Date you request on the Preliminary Information form, your Pension Effective Date may be later.

1 This notice appears on pages 41-43 of the Summary Plan Description – 2013.

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The Fund Office will notify you in writing: 1. when Part 1 of the Pension Application is complete; 2. if you are not eligible for a pension benefit; or 3. if additional items are needed to complete Part 1 of the Pension Application. If you do not provide the additional requested items within 60 days of the date of the Fund’s request, your application will expire and you will need to begin the application process again by completing and returning a new Preliminary Information form.

Part 2: The Choice of Benefit Payment Option form

After the Fund Office has received your complete Preliminary Information form, including all required documents, the Fund Office will begin the work necessary to send you Part 2 of the Pension Application. Part 2 consists of:
 a “Choice of Benefit Payment Option” form for you to choose how your pension benefit will be paid;  an explanation of the benefit payment options;  an explanation of your Spouse’s rights with respect to the available benefit payment options and the
financial effect of waiving the normal form of benefit payment; and  your earliest Pension Effective Date.

You must return a fully completed Part 2 of the Pension Application (Choice of Benefit Payment Option form and spousal consent form, if required) before your actual Pension Effective Date can be determined.

Your Pension Effective Date

Your Pension Effective Date is the first day of the first month for which you receive a pension benefit.  Your earliest Pension Effective Date is the first day of the first month following the month in which the Fund Office receives from you a complete Part 2 of the Pension Application (Choice of Benefit Payment Option form and spousal consent form, if required) if these forms are received at the Fund Office on or before the 15th day of the month. If the forms are received at the Fund Office after the 15th day of the month, your Pension Effective Date is the first day of the second month following the Fund Office’s receipt of your forms.  You may choose a later Pension Effective Date.  Your Pension Effective Date will not change if there is an administrative delay in processing your benefits. In that case, you will receive benefits retroactive to your Pension Effective Date.

If your Pension Effective Date would be more than 180 days after you were provided

with Part 2 of the Pension Application, then your application will expire, and you will

need to begin the application process again by completing and returning a new Part 1 of

the Pension Application.

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