Page 19 - Work Force December 2020

Membership Has its Benefits!
CSEAVISA® CREDITCARD
apply EA
ard.
APPLY www.capcomfcu.org/CSEA (844) 622-CSEA (2732)
$10,000 Accidental Death Benefit
• This valuable benefit is available to you as a member in good standing at no cost to you!
• Since the program began in 2014, this benefit has helped more than 50 families recover from a sudden, tragic loss.
Go to https://cseany.org/10KAD to fill out the beneficiary form.
• Be sure to complete the beneficiary form (online or download and print) so this benefit goes to who YOU designate as well as the Membership Verification/Update form to ensure we have your
most current information in the event of a claim.
• Return completed forms to:
CSEA Insurance Department
143 Washington Avenue Albany, NY 12210
MEMBERS ONLY
Exclusive CSEA Benefit
LOW FIXED RATE
8.90%APR* or 12.90%APR*
SAVINGS & SAFETY
Scan below to for your CS
Visa® Credit C
No Annual Fee
No Balance Transfer Fee
Discounts from VISA and CAP COM Scan QR code to Zero Liability Fraud Protection
apply for your CSEA Visa Credit Card.
Insured by NCUA
*Annual Percentage Rate. Ask for details.
Attention: Public Sector Local and Unit Presidents
Important Election Information:
The term of office for current Public Sector Local and Unit officers will expire on June 30,
2021. Elections for office must be conducted and completed before the new term begins on July 1, 2021.
A letter was sent by the Statewide Election Committee (SEC) in September to each Local and Unit President requesting each Executive Board to select 1) a Chairperson
and Election Committee or 2) an Election Meeting Chair (available to Locals and Units with 150 members
or less), prior to October 15, 2020. Each Local and Unit President was provided with and asked to return the completed Election Committee and Election Meeting Chairperson Data Form along with Executive Board meeting minutes reflecting the appointments.
A reminder to those who have not yet returned the Data Form was sent in mid-November. If this has not been
completed, please do so immediately. Please refer to the SEC’s September letter for procedural requirements or contact the SEC, if you need a copy of the letter and the form.
Once Election Committees/ Election Meeting Chairs are in place, beginning in February 2021, each registered Chairperson will receive an election package from CSEA to assist them in performing their election duties. This material is necessary to have to run a proper election.
CSEA Headquarters cannot send material to any Chairperson, without first receiving the completed Election Data Form from the Local or Unit President.
Any questions pertaining to
the September mailing, or the election process in general, can
be answered by contacting the SEC at 1-800-342-4146, extension 1447 or sec@cseainc.org.
Stay up-to-date on buying discounts at
facebook.com/cseabenefits.
For more information on available discounts, visit https://cseany.org/mb.
December 2020
The Work Force 19
SECTION III – Signature & Attestation
Accidental Death (AD) Beneficiary Form Customer Number TS 05050044-G SECTION I – Insured Information
Group Policyholder Name: Civil Service Employees Association, Inc.
First Name Address – Street City
M.
Last name Non-Work Email State Zip
Date of Birth Phone Number SSN
SECTION II – Beneficiary Information
Complete the section that pertains to the type beneficiary you are designating.
PRIMARY BENEFICIARY - Your first choice to receive your life insurance proceeds in the event of your accidental death. If any primary beneficiaries predecease you, that person's share will be equally divided among any remaining primary beneficiaries.
First Name Address – Street City
M. Last name
Date of Birth
Relationship to Member
% Share
only be listed once. The sum MUST equal 100%.
Relationship to Member
MUST equal 100%.
State
Zip SSN
CONTINGENT BENEFICIARY - Your second choice to receive your life insurance proceeds if ALL of your primary beneficiary(ies) are not living at the time of your death. If any contingent beneficiaries predecease you, that person's share will be equally divided among any remaining contingent beneficiaries.
First Name Address – Street City
M. Last name
Date of Birth
State
% Share
Zip SSN
If you need more space for additional beneficiaries, living trust, or estate, visit www.cseainsurance.com/Products-Forms/Term-Life to download the full form and submit to CSEA, Inc., ATTN: Insurance Dept., 143 Washington Ave., Albany, NY 12210.g
SECTION III – Signature & Attestation
I hereby authorize the Civil Service Employees Association, Inc. (CSEA), Local 1000 AFSCME, AFL-CIO, to be my exclusive representative for collective bargaining and therefore revoke any other representative that I may have previously designated. I also hereby authorize the fiscal or payroll officer of my employer to deduct CSEA dues from my salary in the amount certified by CSEA in this and succeeding years of my employment and membership. Dues, contributions or gifts to CSEA are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses.
I hereby revoke any previous designations, and I designate the person, people, or entity named in Section II as Beneficiary(ies). I reserve the right to change or revoke this designation at any time.
Job Title
First Name Address – Street City
M.
Place of Employment/Location Last name
Non-Work Email Address Date of Birth
Phone Number
SSN
I acknowledge that my membership entitles me to this $10,000 AD policy.
Member Name (Please Print) Member Signature Date (Must be date form was completed)
Phone Number
You MUST designate at least one primary beneficiary. A person may
The sum of the Primary & Contingent Beneficiary percentages
Dollar amounts, fractions and decimals will not be accepted.
Member Record Verification/Update
I hereby authorize the Civil Service Employees Association, Inc. (CSEA), Local 1000 AFSCME, AFL-CIO, to be my exclusive representative for collective bargaining and therefore revoke any other representative that I may have previously designated. I also hereby authorize the fiscal or payroll officer of my employer to deduct CSEA dues from my salary in the amount certified by CSEA in this and succeeding years of my employment and membership.
Dues, contributions or gifts to CSEA are not tax deductible as charitable contributions. However, they may be deductible as ordinary and necessary business expenses.
State
Zip
I acknowledge that I am a Member in good standing, which entitles me to this $10,000 AD policy.
Member Name (Please Print) Member Signature Date
Phone Number