To receive all benefits all fields must be completed.
I hereby certify that work has been unavailable to me for the hours specified below. I understand that my benefits are paid from the Contractors Advantage Supplemental Unemployment Benefits Plan Trust and are exempt from FICA tax obligations. Further, I agree to provide additional supporting documentation upon request of the Plan Administrator or its agent as necessary to establish my entitlement to Plan benefits, and I acknowledge that failure to provide such documentation and to meet the requirements of the Summary Plan Description provided to me previously may result in (i) my benefit request being denied, (ii) my repayment to the Trust of benefits I have been paid, and/or (iii) FICA tax consequences that are my sole responsibility.
I understand that to receive benefits from the Trust in the current week I must provide this request by 12:00 p.m. Tuesday. Requests submitted after 12:00 p.m. on Tuesday will result in benefits being paid the following week. I also understand that I will receive benefits only if I have funds remaining in my Plan account under the Trust.
All form fields are required.