Union - Factory and Group Program

Authorization for PAYROLL Deduction

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Emergency Contact

(1) TCT CAREGIVING ANNUITY AGENT WILL CONTACT YOU AFTER YOU SCHEDULE A TIME THROUGH THE CALENDAR BELOW, WITHIN 48-72 HOURS. THIS WILL DEPEND ON AVAILABILITY AND DATES THAT ARE AVAILABLE. (2) AT THE TIME OF YOUR CALL YOU WILL BE PLACED IN THE PLAN THAT YOU QUALIFY FOR OPTIONS 1,2,3 RETIREMENT PROGRAMS.

By checking the box, I authorize TCT CAREGIVING to deduct $49 from my weekly check. This is for the purpose of Payment for my Health and Wealth Annuity Benefit Program.