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Request and Authorization for Voluntary Allotment of Compensation for Payment of Employee Organization Dues.

* Denotes Mandatory Fields
SECTION A – All New Members Complete
 Your title determines whether you also complete Sections B or C.

 
USPS Employee Identification Number:*

 
Social Security Number:

Date of Birth:

Home Phone:

Gender:

   

Employee Name:*

Your Nickname:

Home Address:*

City:*

State:

Zip:*

Personal E-Mail Address:

Total Years of Postal Service:
       
SECTION B – Postmasters Only Complete

PO City:

PO State:

PO Zip:

PO Finance #:

PO Level:

PM Direct Phone Number:
       
– SECTION C – Check One
 Officer-in-Charge Associate PMR – Only Complete

PO City/State

PO Finance #
of OIC Detail:

Date of PM/OIC
Appintment

PO Phone Number:

Former PM at this
Office has
Retired Date: Detailed to:

Home Payroll Office Finance #

Employee Designation Code:

 
SECTION D – For Use by the Employee Organization

P

 Mail completed form to:
National Association of Postmasters of the United States (NAPUS)
8 Herbert Street
Alexandria, Virginia 22305-2600
I hereby certify that the regular dues of this organization for the above-named member currently are established
at $________________ per calendar month.
Signature and Title of
Authorized Official 		NAPUS Membership Chair
NAPUS Chapter Sec.-Treas.		 Date:
Member submitted as: Witholding Cash ( attach check/money order)

SECTION E– Authorization by Employee
 Please review this text and check the box to signify digitally sign this form.

 

I hereby authorize the above-named agency to deduct from my pay the first pay period of each month the amount certified above as the regular dues the (UN-P) National Association of Postmasters of the United States (NAPUS) and to remit such amounts to that employee organization in accordance with its arrangements with my employing agency. I further authorize any change in the amount to be deducted that is certified by the above-named employee organization as a uniform change in its dues structure.

I understand that this authorization is a monthly deduction. It will become effective the first pay period of the calendar month, which includes the first day of the month, following its receipt in the employee organization’s headquarters office: NAPUS, 8 Herbert Street, Alexandria,VA 22305-2600.

I further understand that revocation forms — Standard Form No. 1188, “Revocation of Voluntary Authorization for Allotment of Compensation for Payment of Employee Organization Dues” — are available from my employing agency and that I may revoke this authorization at any time by filing such a revocation form or other written revocation request “Certified Mail” directly to the employee organization’s headquarters office:

NAPUS
8 Herbert Street
Alexandria, VA 22305-2600.

Such revocation will not be effective, however, until the first full pay period following March 1 or Sept. 1 of any calendar year, whichever date first occurs after the revocation is received in the employee organization’s headquarters office.

Signature of Employee:



SECTION F

Check this box to signify that you've read and understand the terms outlined in Section E of this form.
Yes, at the same time I join NAPUS, I'd like to join NAPUS Federal Credit Union and also receive a NAPUS FCU Visa card, if I qualify! After I received my Credit Union account card in the mail, I understand I may call PostalEASE
(1-877-477-3273) and set up a payroll allotment to NAPUS FCU the CU's routing number is 254074934.

Who/what most influenced your decision to join NAPUS?

NAPUS NATIONAL OFFICE FOR PROCESSING