D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

pension
plan

        
 
 
 
 
 
     
   
 
 
 
 
 

Statement of Claimant Form

Use
After the Plan Member has died, the Member's beneficiary should complete the Statement of Claimant form to notify the Plan Administrator of the Member's death and select how he/she wishes to receive the Member's Pension benefit that has accumulated in the Plan.


Information Needed to Complete the Form
To complete the form, the beneficiary must provide:

  • Member's personal information
  • Beneficiary's personal information, and
  • Method of payment of Pension funds.
The original death certificate (or a notarized copy) must be submitted with this form.

Depending on the method of payment selected by the beneficiary, additional forms may need to be submitted as outlined on the form or advised by the Plan Administrator.


Notes
Completed forms should be forwarded to the Plan Administrator.



Frequently Asked Questions
What do all these types of Pension options mean?
  • You may wish to consult a personal financial advisor to determine which Pension type best meets your needs.

Other questions on completing the form should be directed to the Plan Administrator.


 

Form Link
Statement of Claimant Form
 

Related Links
Information on Leaving the Plan
 
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