Get Fringe Benefit Statement
___ __________________________________________ $ ____________________ __________________________________________ Subsistence and/or Travel Pay Apprentice/ Training $ ____________________ __________________________________________ Other $ ____________________ $ ____________________ CLASSIFICATION Effective Date FRINGE BENEFIT HOURLY AMOUNT Vacation ________________________ Health & Welfare ________________________ Pension NAME AND ADDRESS OF PLAN, FUND OR PROGRAM $ ___________________.
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