FLIGHT ATTENDANT REQUEST
EARLY RETIREMENT INCENTIVE (ERI)
NAME: ____________________________________ EMPLOYEE NUMBER: ____________________
REQUESTED RETIREMENT DATE: ______________________
In accordance with the 2004 AFA-US Airways Collective Bargaining Agreement, I am notifying the Company by March 1, 2005 of my intent to retire on the above-listed retirement date. I am doing so in order that I may be eligible for certain severance payments available under the
ERI. I understand that eligibility for these payments consists of the following:
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I was "active" as of December 1, 2004. Active status for purposes of the ERI includes flight attendants actively flying the line, claiming paid sick leave, taking FMLA/PCL leave, or on military leave. Flight attendants on non-FMLA/PCL or non-military leaves of absence such as personal, unpaid medical, long-term disability, or voluntary furlough shall not be considered active.
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Effective on my retirement date, I will have at least 20 years of service as a flight attendant with US Airways.
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Effective on my retirement date, I will be at least 55 years of age.
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The effective date of my retirement is not earlier than January 2, 2005 and not later than December 31, 2005. Note: Those flight attendants who retired effective January 2, 2005 through March 1, 2005, do not have to fill out this paperwork and will receive confirmation after March 1, 2005 of their eligibility for ERI severance payments. Flight attendants who have already submitted a request to retire after March 1, 2005, are asked to submit this form if they are eligible and interested in the ERI.
By submitting this paperwork, you are only notifying the Company of your request to receive ERI severance payments if you are eligible. You must submit separate applications for any other benefits to which you may be entitled. For example, you must contact the Pension Benefit Guaranty Corporation (PBGC) to apply for a pension benefit under the Retirement Plan for Flight Attendants in the Service of US Airways, Inc. You will also be contacted by Benefits Administration to ascertain whether you are interested in continuing to receive any health care benefits you may be entitled to through the provisions of your Collective Bargaining Agreement.
This form must be received by Inflight Administration by no later than March 1, 2005, if you want to be considered eligible for ERI severance
payments. It is your responsibility to ensure that we have received your request. You may confirm our receipt by checking the searchable list on theHub or by calling 1-800-327-0117, Prompts 1, 5, 4, 5. Late requests will not be accepted.
Please note that any changes to your requested retirement date made after March 1, 2005, will make you ineligible for ERI severance payments.
SIGNATURE: _____________________________________________ DATE: ________________
SUBMIT COMPLETED REQUEST TO: