Employee Application Form
The Employee Application form is used to enroll new employees who are eligible to participate in the pension plan. The employer completes the information on the reverse side.
Participant Change Form
Complete an Participant Change form if you wish to change personal information such as name, address, or beneficiary change. If beneficiary change is due to death or divorce of spouse, proof of event must be provided or a Declaration of Marital Status Form must be completed.
To begin receiving retirement benefit payments, the Application for Retirement Benefits and the Declaration of Marital Status (links below) must be submitted 25 to 180 days before your first benefit payment. The forms must be completed and received before benefit payments can begin. Benefit payments are made on the 25th of the month.
Prior to initiating your benefit payments, you are welcome to use the online Retirement Calculator to estimate your payment amount for the available benefit payment options or contact Brenda Addie to request an estimate and/or application packet (877.274.8796, ext 227; 616.284.3227; email@example.com).
Once you are retired and receiving monthly benefit payments, contact Sue Shaffer, Retiree Administrator, for assistance with your pension benefit payments (877.274.8796, ext 258; 616.284.3258; firstname.lastname@example.org).
- Application for Retirement Benefits – Choose your benefit payment option.
- Declaration of Marital Status Form – Verify your marital status at retirement.
- Direct Deposit Form – Deposit your payment directly into your bank account or make a change to your direct deposit account in the future.
- Federal Income Tax Withholding Form W-4P – Declare or change your federal income tax withholding preferences.
- State Income Tax Withholding - Declare or change your state income tax withholding preferences. If your state is not listed below, please contact the state directly for an applicable form.
- Retiree Change Form – Change personal information including marital status, address/phone/email, report death of a spouse, etc. You may contact us directly with this information as well.
- Benefit Payment Participant Web Passport – Set up your personal account and sign in securely to access your pension benefit payment information. Review payment status and history; update address, tax and direct deposit information. (To set up your secure log-in, you will need your last payment payable date and net amount paid. Contact Sue Shaffer for assistance with this information: 877.274.8796, ext 258; 616.284.3258).
- Visit https://www.northerntrust.com/benefitpaymentsus, CSI's payroll administrator website for additional information, helpful links and tutorials regarding your monthly pension benefit payment.
Declaration of Marital Status Form
This Declaration of Marital Status form is used if your marital status has changed due to a divorce. This form is also completed when applying for retirement benefits.
Disability Benefit Application Forms
The following forms are used to apply for temporary disability benefits An Application for Temporary Disability Benefits of which Part I is completed by the employee and Part II by the employer.
A Certification of Disability form of which Part I is completed by the employee and Part II by the attending physician.
The IRS W-4S form is used to select the amount of income taxes withheld from your disability payment.
- Optional Direct Deposit – Complete this form if you would like to have the payment directly deposited into your checking account.
Cash Refund/Transfer Forms
The forms below are for participants who are no longer contributing to the Plan through a participating employer. For specific information about your account and the amount available for withdrawal, please contact Brenda Addie at email@example.com.
- Available state tax withholding forms (if your state is not listed below, please contact the state directly for an applicable form):