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Pension Forms

Pension Electronic Direct Deposit Form

Pension Electronic Direct Deposit Form

1) Use this form when you want to elect to have your monthly pension benefit deposited directly into your account.

2) You must fill out the form and submit back to the Fund Office. If you elect to have this benefit deposited to your checking account, a copy of a VOIDED CHECK is required.

3) Please mail the completed form along with your Pension Application to:

Equity-League Pension Trust Fund

Attn: Retirement Services Department

165 W 46 St, 14th Fl

New York, NY 10036

4) The Equity-League will process your request. If additional information is required, a Customer Service Representative will contact you.

Tax Withholding Form W-4P (Federal Tax withholding's)

Tax Withholding Form W-4P (Federal Tax withholding’s)

Use the W-4P form for tax withholdings from you pension.

Health Premium Withholding Form

Health Premium Withholding Form

If you currently receive a pension from the Equity-League Pension Plan, you can elect to have your monthly health and/or dental premium deducted from your monthly pension payment. If you do this, you’ll never have to worry about missing your health and/or dental premium due date again (assuming that your pension exceeds your health/dental insurance premium).

1) Please print, complete and sign this authorization form, and

2) Return it to:

Equity-League Benefits Services Department

165 W 46 St, 14th Fl

New York, NY 10036

Once we receive the completed form, we’ll confirm when your health/dental premium will begin to be deducted from your monthly pension payment. Please do not stop paying for your health premium until you have received confirmation of this deduction.

This deduction will continue with each premium payment due, unless you revoke your authorization. You may do that at any time by sending us a written request. Such revocation shall be effective as of the first of the month following the receipt of such revocation as long as the revocation is received 10 business days or more prior to the first of the month. If your request is received later than that, it will take effect on the first of the following month.

Pension Beneficiary Designation/Change Form

Pension Beneficiary Designation/Change Form

1) Print this form in order to designate or change a beneficiary under the Equity-League Pension Plan.

2) Fill out the form (if you are married and have not elected your spouse as your primary beneficiary, your spouse will have to provide consent and the form must be notarized).

3) Sign and date the form.

4) Please mail the completed form to:

Equity-League Pension Trust Fund

Attn: Retirement Services Department

165 W 46 St, 14th Fl

New York, NY 10036

Pre-Retirement Spousal Rejection Form

Pre-Retirement Spousal Rejection Form

1) Print the Pre-Retirement Spousal Rejection Form when you are naming someone other than your spouse as beneficiary.

2) You and your spouse must complete and notarize the form.

3) Please mail the completed form to:

Equity-League Pension Trust Fund

Attn: Retirement Services Department

165 W 46 St, 14th Fl

New York, NY 10036

4) Equity-League will process and record your request. If additional information is required, a representative from the Retirement Services Department will contact you.

Pension Designation forms for Canadian Actors' Equity Reciprocal agreements

Reciprocal benefits between Actors’ Equity and Canadian Actors’ Equity Association Forms:

For Canadian Actors working under Actors’ Equity agreements in the U.S.

For U.S. Actors working under CAEA agreements in Canada or the United States

1) Use the appropriate Pension Designation Form to designate your pension benefits to your applicable union (Actors’ Equity or CAEA). Use the Pre-Retirement Spousal Rejection Form when you are naming someone other than your spouse as beneficiary.

2) Fill out the form and all fields.

3) Please mail the completed form to the address at the bottom of the form.

Domestic Partners Affidavit For Pension Fund

Domestic Partners Affidavit For Pension Fund

A formal domestic partnership is an important means to assure that your partner receives certain benefits.  However, Federal law does not recognize the domestic partners as being entitled to all of the benefits reserved for “spouses”.  For example, a domestic partner is not entitled to the protections of the spousal waiver and qualified domestic relations order provisions of the Internal Revenue Code and the Employee Retirement Income Security Act of 1974, as amended, therefore, if you wish your domestic partner to be eligible to receive a lifetime survivor annuity should you die pre-retirement and before your domestic partner you must follow these instructions.

Because the Equity-League Pension Plan now allows a participant to identify any beneficiary he/she chooses as his/her beneficiary for the post-retirement pension benefit, you are not required to execute the domestic partner affidavit in order for your domestic partner to be named as the beneficiary to your post-retirement pension benefit.

Designation of Domestic Partner to Receive Pre-Retirement Survivor Annuity

1) You must complete and NOTARIZE the forms labeled “Equity-League Pension and Health Fund Affidavit of Domestic Partnership” and “Attachment 1, Declaration of Financial Interdependence.” Please note that if your state or municipality allows the registering of Domestic Partners you must register with such state or municipality and attach a copy of the registration to the Affidavit. If you submit proof of Domestic Partner registration or a certificate of marriage (from a jurisdiction legalizing same-sex marriage), you do not need to submit the Declaration of Financial Interdependence or further proof of financial interdependence.

2) You must designate your domestic partner as your beneficiary. If you have not already done so, request a beneficiary form from the Fund Office and enclose it with your application.

3) Please mail the competed forms and premium to:

Equity-League Pension Trust Fund

Attn: Retirement Services Department

165 W 46 St, 14th Fl

New York, NY 10036

4) The Fund Office will process your application. If additional information is required in order to process your request, the Fund Office will contact you.

5) In order for you to name your domestic partner as your beneficiary to your pre-retirement pension benefit, you must:

a. Have satisfied the Fund’s definition of Domestic Partner for one year prior to your death for your partner to receive a survivor annuity. If you satisfy the Fund’s domestic partnership test by demonstrating that you and your domestic partner have lived together continuously for six or more months, your domestic partner will not be eligible to receive a death benefit until the one-year anniversary of the date you two lived together for six months. For example, if you and your domestic partner begin to live together on January 1, 2004, you will not be considered “domestic partners” under the Fund until July 1, 2004. Therefore, your domestic partner will not be eligible to collect a survivor benefit if you die pre-retirement until July 1, 2005;

b. Complete the Domestic Partner Affidavit;

c. Name your domestic partner as your beneficiary on the Pension Fund’s beneficiary designation form; and

d. Be vested in your pension at the time of your death.

If these conditions are satisfied, your domestic partner will receive the Fund’s retirement survivor annuity if you die before you retire.

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EQUITY-LEAGUE HEALTH FUND DOMESTIC PARTNER COVERAGE

1. Definition of Domestic Partners

Equity-League Health Fund defines domestic partners as follows:

Two adults (both of whom are 18 years or older) of the same or opposite sex, neither of whom is married (to anyone other than the domestic partner) or legally separated who:

a) either:

i) resided with each other for six months prior to the application for benefits and who intend to live continuously with each other indefinitely, or

ii) were legally married in a state or country legalizing same-sex marriage;

b) are not related by blood closer than the law would permit by marriage;

c) are financially dependent on each other;

d) have an exclusive close and committed relationship with each other;

e) have not terminated the domestic partnership; and

f) if eligible under (a)(i) above, and living in a state or municipality providing for the registration of domestic partnerships, have registered as domestic partners.

2. Procedure for Verifying Domestic Partner Status

A participant who seeks domestic partner coverage is required to submit an affidavit attesting to the domestic partner status and a declaration of financial interdependence with two items of proof (such as joint lease or mortgage, joint bank account). (A sample affidavit and declaration is attached).

Persons who fraudulently, wrongfully (or negligently) obtain coverage for persons who are not entitled to such coverage, or who fail to timely notify the Plan Administrator of the termination of a domestic partnership, may be subject to disciplinary and/or civil action. You will be required to refund the Fund Office for the costs associated with the wrongfully extended coverage.

In addition, those who live in states or municipalities offering a domestic partner registry (such as California and New York City) will be required to show proof that they have registered as domestic partners.

3. Domestic Partner Coverage for Pre-Retirement Benefit

If you submit the beneficiary designation form and designate your domestic partner as your beneficiary for pre-retirement benefits, your domestic partner will receive a pre-retirement survivor annuity under the Plan if you die after you are vested but before you retire, provided you satisfied the Fund’s definition of a domestic partner for at least twelve months prior to your death. If you are vested and die before satisfying the domestic partner definition for at least twelve months but have designated your domestic partner as a beneficiary, your domestic partner will be entitled to the applicable death benefit for a single participant.

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4. Modification and Interpretation

The Trustees reserve the right to amend or modify the eligibility requirements for domestic partner coverage and to amend, modify or terminate domestic partner coverage at any time for any reason. The Trustees reserve the right to interpret all plan documents concerning domestic partner coverage and to interpret the requirements for and extent of such coverage.

Domestic Partners Affidavit Form For Pension Fund

Declaration of Financial Interdependence For Health Fund

Re-designation of Former Spouse as a Beneficiary Form

Re-designation of Former Spouse as a Beneficiary Form

1) Complete, sign and date the form:

2) Please mail the completed form to:

Equity-League Trust Fund

Attention: Retirement Services Department

165 W 46 St, 14th Floor

New York, NY 10036

Pension Application Materials

Very Important Note: Federal law prohibits our accepting your pension application materials until we have provided you with a document called “Important Information About Your Pension”. If your application is dated before you receive that document, we will be forced to reject it.

Your pension application materials consist of four forms. In order to receive your pension, you must complete these pension forms (including the “Election of Benefit Payment Form”):

  1. The pension application form (6 pages) must be signed, and your signature notarized. (If you submit your application in person at the Fund Office, certain Fund Office staff members can witness your signature instead).You must also submit proof of your age.
  2. If you are married and choose a Spouse’s Pension, you must also include a copy of your marriage certificate. If you elect a Spouse’s Pension or a Joint and Survivor Annuity, you must also submit proof of your spouse’s or designated beneficiary’s age.
  3. The “Authorization Agreement For Electronic Deposits” form that tells us where to send your monthly pension payment.
  4. The one page Tax Withholding Form W-4P controls your federal tax withholding status. By completing and returning the Form W-4P, you can elect withholding of either: a) a flat dollar amount, b) an amount based on your marital status and the actual number of withholding allowances to which you are entitled, or, c) you can elect not to have federal income tax withheld from your pension payments. If you do not elect otherwise by completing this withholding form, tax will be withheld from your pension based on the assumption that you are married and entitled to three (3) withholding allowances.
  5. If you are married and choose a form of payment other than a Spouse’s Pension, you must also submit the Spouse’s Consent form, which must include his or her notarized signature (this is the last page included in the pension application package).

Once you have completed your application, it must be returned to:

 Equity-League Trust Fund

Attention: Retirement Services Department

165 W 46 St, 14th Floor

New York, NY 10036

Additional copies of these forms may be obtained from the Fund Office, at the above address.

Career Information Table

Career Information Table

1) Use the Career Information Table to list all of your past employment between 1945 and 1964.

2) The participant must fill out the form and wherever possible submit originals or copies of dated programs, dated newspapers or magazine articles, contracts, or page numbers for theatrical references as verification of the employment listed.

3) Please mail the completed form along with your Pension Application to:

Equity-League Pension Trust Fund

Attn: Retirement Services Department

165 W 46 St, 14th Fl

New York, NY 10036

4) The Equity-League will process your request for a pension. If additional information is required, the Pension Claims Examiner will contact you.