Pension Application Instructions

General Information

. File your Pension Application no more than 180 days before you want to receive your pension benefits. Any Pension Application filed more than 180 days before your Annuity Starting Date will be denied. You will be required to file a new Pension Application and establish a new Annuity Starting Date.

. Your Annuity Starting Date is the date established for which monthly pension benefits will be effective.

. Postmark or deliver your Pension Application to the Fund Office by the 14th day of the month prior to the month you want your pension benefits to be effective. For example, if you want your benefits effective in February, postmark or deliver your Pension Application by January 14.

. If all necessary documentation (i.e. proof of age, proof of marital status, etc.) requested with your Pension Application is not immediately available, forward the completed Pension Application to the Fund Office to establish your filing date and Annuity Starting Date. Benefits will be based on this date even though remaining documents will be received later. Benefit payments are retroactive to your Annuity Starting Date and will begin when all documents are received and your application is approved.

. PRINT all information in blue or black ink.

. We will make every effort to process your Pension Application as quickly as possible. If additional information is required to process your Pension Application, the Fund Office will notify you in writing.

Section 1 – Participant Information

. Complete all personal information. Provide both your mailing and physical addresses.

. To receive your pension you will need to provide acceptable proof of age and proof of your marital status. If you are married and elect one of the Husband and Wife Options, we will also need proof of age for your spouse. Refer to the list on Page 2 of acceptable documents to verify age for you and your spouse, if married, and your marital status. Additional documents may be required if the documents you submit are not legible.

. Copies of proof of age/marital status are acceptable. Do not submit original documents. If you submit an original certified document as proof, the Fund Office will not be held responsible for any documents lost in the mail.

Revised August 2017

o Proof of Age - Submit ONE document from this group • A statement/letter from the Social Security Administration providing the date of birth established • Adoption Certificate • Baptismal certificate or a statement as to the date of birth shown by a church record, certified by the custodian of such record • Birth certificate • Hospital birth record, signed by custodian of such record • Immigration papers • Marriage records showing the age or date of birth (application of a marriage license, church record) signed by the custodian of such record or a marriage certificate • Medical Health Insurance Card if effective on 65th birthday • Military Record showing age or date of birth • Naturalization record • Notification of registration of birth in a public registry of vital statistics • Passport • School record certified by the custodian of such record

o Proof of Marital Status - Submit ONE document from this group • Marriage certificate (not a marriage license) • Church record signed by the custodian of such record • Common Law Affidavit (Complete the Pension Trust Office common law form and submit with the required supporting documentation as approved by the Pension Trust.) • Divorce Decree (file stamped by the court) • Separation Agreement (file stamped by the court) • Copy of your spouse’s Death Certificate

. If you plan to elect one of the Husband and Wife Pension Options (see Section 9), you must provide proof of age for your spouse.

Section 2 – Pension Type

. Questions about your pension eligibility should be directed to the Fund Office. You may retire on one of three types of pension:

o Age Pension – A periodic benefit payable at Normal Retirement Age or older that continues for the rest of your life. Age Pensioners will have a form titled “Work Activity after Normal Retirement Age” included with this packet. If this form is not returned to the Fund Office, benefits will not be processed.

o Early Retirement Pension– A periodic benefit payable no earlier than age 55, up to age 65 that continues for the rest of your life.

o Disability Pension – A periodic benefit payable at any age prior to age 65.

Revised August 2017 Page 2 of 8 • For a Disability Pension, verification of your entitlement to Social Security Disability, Social Security Supplemental Income, Railroad Retirement Disability, or Canadian Pension Plan Disability benefits offered by the Department of Human Resources and Skills Development Canada is required. Attach a copy of all pages of the Notice of Award issued by the Social Security Administration, Railroad Retirement Board, or Canadian Human Resources and Skills Development.

Section 3 – Pension Annuity Starting Date

. Your Annuity Starting Date is the date established for which monthly pension benefits will be effective.

Section 4 – Past Employment

. It is important to complete this section as this information may be used in the calculation of your pension benefits.

. Provide your Union Initiation Date.

. If you indicate YES on Uniformed Services, attach a copy of Form DD214. The Uniformed Services includes the following: U.S. Armed Forces, Coast Guard, Army National Guard, Air National Guard, the commissioned corps of the Public Health Service, and any other categories of person designated by the President in the time of war or national emergency.

. If you worked in Canada as a Boilermaker, determine your eligibility for benefits by contacting McAteer Group of Companies, Employee Benefit Plan Services, 45 McIntosh Drive, Markham, Ontario L3R-8C7, toll free 800-263-3564 or Bilsland Griffith Benefit Administrator, Suite 1000 – 4445 Lougheed Highway, Burnaby, BC V5C 0E4, toll free 877- 926-4537.

Section 5 – Current Employment

. If your current employer DOES make contributions to the Pension Fund, indicate your anticipated last day of work. You and your employer must complete the enclosed Separation from Service Verification Form dated on or after your last day of work, verifying the date your employment terminated.

. If your current employer DOES NOT make contributions to the Pension Fund, list the name of your employer, your job duties, and your anticipated last day of work. After the Fund Office reviews your Pension Application, you may be required to provide a letter from your current employer detailing your job classification and duties.

. If you are unemployed indicate your last day of work and the name of your last employer. You and your employer may be required to complete the enclosed Separation from Service Verification Form verifying the date your employment terminated.

Revised August 2017 Page 3 of 8 Section 6 – Declaration of Retirement

. Review this section carefully as it explains the rules governing retirement and disqualifying employment during retirement.

. Your signature at the end of the Pension Application certifies you have reviewed and understand the information provided in this section.

Section 7 – Pension Benefit Tax Withholding Election

. Review the information provided in the Pension Application about tax rules governing pension payments. Indicate by checking one of the boxes whether you DO or DO NOT want federal income tax withheld from your pension. Generally, you may not elect out of withholding if payment is delivered outside of the United States or its possessions.

. If you DO want federal income tax withheld, indicate your marital status by checking one of the boxes and providing the number of allowances you want to claim and/or any additional amount you want to withhold.

. If you reside in a foreign country or you are not a U.S. citizen, you are required to complete an IRS Form W-9 or W-8BEN, as appropriate. Contact the Fund Office and the applicable form will be mailed to you.

Section 8 – Pension Benefit Payment Election

. Review the enclosed Qualified Joint & Survivor Annuity Notice, Relative Value and Right-to-Defer Notice, and your Benefit Payment Election Estimates before you complete this section. Your Benefit Payment Election Estimates have individualized information that may help you make your benefit election. Upon final approval of your Pension Application, your Pension benefit amount may be different than the Benefit Payment Election Estimates provided to you..

. To elect one of the Husband and Wife Options, you and your spouse must be married to each other on your Annuity Starting Date. If you elect one of the Husband and Wife Options and you die prior to being married to your spouse for a minimum of twelve months, the Husband and Wife Option is not valid and your Pension will be recalculated as outlined below:.

o If you are a Grandfathered Active Participant your benefit will be recalculated as a Single Life Annuity with the 60 Months Certain Option for the portion of your benefits accrued prior to October 1 2012, and as a Single Life Annuity with no remaining payments for the portion of your benefits accrued on or after October 1, 2012. The remainder of the benefits, if any, at your death will be issued to your designated beneficiary.

o If you are not a Grandfathered Active Participant your benefit will be recalculated as a Single Life Annuity with no remaining payments.

Revised August 2017 Page 4 of 8 . If you are married, elect whether you DO or DO NOT want to receive your benefits in the form of a Husband and Wife Pension. If you DO want to receive a Husband and Wife Pension, then you need to elect the 50%, 75% or 100% Husband and Wife Pension option:

o 50% Husband and Wife Pension – You will receive a reduced* monthly benefit during your lifetime and upon your death, your surviving spouse will receive a monthly benefit equal to one-half the amount you were receiving at death, for the rest of his or her life. (*If you are a Grandfathered Active Participant and if you retire at age 58 or older with 30 or more years of Pension Credits, there will be no reduction for the 50% Husband and Wife Pension for the benefits accrued prior to October 1, 2012. For the benefits accrued on or after October 1, 2012, the benefits will be reduced to the actuarial equivalent of the Normal Form for that time period, the Single Life Annuity.)

o 75% Husband and Wife Pension – You will receive a reduced monthly benefit during your lifetime and upon your death, your surviving spouse will receive a monthly benefit equal to 75% of the amount you were receiving at death, for the rest of his or her life.

o 100% Husband and Wife Pension – You will receive a reduced monthly benefit during your lifetime and upon your death, your surviving spouse will receive a monthly benefit equal to 100% of the amount you were receiving at death, for the rest of his or her life.

. NOTE: If you elect one of the Husband and Wife Options and you are subsequently divorced after your Annuity Starting Date, your spouse will still receive his or her portion of the benefit at your death, payable for his or her lifetime.

. If you are single, or if you are married and DO NOT want to receive a Husband and Wife Pension, you may choose from the Single Life Annuity, Single Life Annuity with 60 Months Certain or Single Life Annuity with 120 Months Certain forms of benefit:

o Single Life Annuity - You will receive a monthly pension for your lifetime. At your death, all pension payments stop.

o Single Life Annuity with 60 Months Certain - You will receive a monthly pension for your lifetime. If you die before receiving 60 payments, the benefits will continue to your beneficiary(ies) until a total of 60 payments have been made. If you die after a total of 60 payments are made, no further benefits are payable from the Plan.

o Single Life Annuity with 120 Months Certain - You will receive a reduced monthly pension for your lifetime. If you die before receiving 120 payments, the benefits will continue to your beneficiary(ies) until a total of 120 payments have been made. If you die after a total of 120 payments are made, no further benefits are payable from the Plan.

Revised August 2017 Page 5 of 8 Section 9 – Pension Beneficiary Designation

. This section designates a beneficiary (ies) for any remaining payments under the Single Life Annuity with 60 Months Certain or the Single Life Annuity with 120 Months Certain payable at death.

. Provide the full name of the person whom you want to receive these benefits, his or her Social Security number, date of birth, relationship to you (i.e. wife, husband, son, friend, etc.), and address.

. If you list multiple beneficiaries, each beneficiary will share any benefits equally, unless you specify otherwise.

. If any beneficiary(ies) predeceases you, his or her share will be payable to the remaining designated beneficiary(ies).

. You should periodically review your beneficiary(ies) designation(s) in the event any changes are necessary. To change your beneficiary(ies), contact the Fund Office.

. In the event your marriage is terminated due to divorce or annulment, any designation naming your spouse as beneficiary shall be deemed null and void as of the date of the termination unless you redesignate your ex-spouse as your beneficiary following the termination.

Section 10 – Participant Signature and Acknowledgement

. Check the box if you want to waive the 30-day waiting period. If you do not check this box, your Annuity Starting Date may be delayed.

. Sign and date the Pension Application declaring and certifying you have reviewed and understand all information provided, and the information you provided is accurate to the best of your knowledge. If you are married and you waive the 30-day waiting period, your spouse must also sign and date the Pension Application in this section.

Section 11 – Spousal Consent and Acknowledgement – If You Reject the Husband and Wife Pension

. If you are married and elect a form of benefit payment other than one of the Husband and Wife Options, your spouse must consent to the form of benefit you elected. In addition, if you are married and electing the Single Life Annuity with 60 Months Certain or 120 Months Certain and you name a beneficiary other than your spouse, spousal consent is necessary.

. Your spouse must elect whether you (the participant) may or may not change your benefit payment election or beneficiaries without his or her consent.

Revised August 2017 Page 6 of 8 . Your spouse must sign and date the Pension Application in front of a Notary Public or Plan representative declaring he or she has reviewed and understands all information provided, and the information he or she provided is accurate to the best of his or her knowledge.

. The Notary Public or Plan representative must witness your spouse’s signature. Both the Notary Public seal and signature are required.

. The Spousal Consent will only be valid if the date of your spouse’s signature and the date of the Notary’s signature are the same.

Section 12 – Submitting Your Pension Application

. Complete the checklist provided on the Pension Application to make sure you have compiled all necessary documentation needed to process your pension.

. Once the checklist is completed, mail your Pension Application and required documentation to:

Boilermaker-Blacksmith National Pension Trust PO Box 909700 Kansas City, MO 64190

If you have questions about completing your Pension Application, please call the Pension Department at 866-342-6555 or 913-342-6555, 8:00 am to 5:00 pm CST, Monday thru Friday. We will be happy to assist you.

Revised August 2017 Page 7 of 8 Pension Direct Deposit

. We encourage you to take advantage of Direct Deposit as a safe and quick way to receive your pension payments. Electing Direct Deposit means your pension payments will be electronically deposited in your account automatically on the first working day of the month. Direct Deposit protects your payments from being lost, stolen or misplaced in the mail. Additionally, you no longer have to make a special trip to the bank to deposit your check.

. If you elect Direct Deposit, your first payment(s) will be sent directly to you in paper check form. Your first electronic payments will begin within 30 to 60 days of your first benefit payment.

. You will need to provide information about the financial institution where you want to electronically deposit your payments.

. It is important that you attach a voided check with your Pension Application. Your name and address must be pre-printed on the voided check. Direct Deposit will not be processed without a voided check unless we have a signature from your Financial Institution.

. Provide the account number and routing number. These numbers can be found on the bottom of a check. The routing number is listed first and must be 9 digits and match your voided check. In the example shown below, the routing number for this check would be 123456789. The account number is the next set of numbers. In the example below, the account number would be 987654321.

John Doe 3333 555 Elm Anytown, USA 55555 This is the ______$ _____ account number This is the ______Dollars routing number VOID Memo______

123456789 987654321 3333

. Please verify your voided check information matches the information you provide on the Pension Application Form.

Revised August 2017 Page 8 of 8