If you have a change of address please fax to:

MICHIGAN U.P. IBEW PENSION PLAN

(906-226-2221)

CHANGE OF ADDRESS

                                Name                                                              

                                 OLD ADDRESS:

                                  Street:                                                             

                                 City,Zip:                                                          

                                 NEW ADDRESS:

                                  Street:                                                             

                                  City,Zip:                                                            

                                  Phone number                                                   

                                  Effective Date:                                                  

                                  Temporary             Permanent                                                                                                                                              

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