Teamsters Local 896

Withdrawal Request

First Name *

Last Name *

Phone *

Email *

Last 4 digits of SS# *

Date of last day worked *

Request Reason *

Please list the reason of your Withdrawal request, i.e. Medical, FMLA, Resignation, Worker's Comp.

Your employer and location *

Other than paid time off, if you leave the industry or shop for any reason including Leave of Absence, you must request a withdrawal card within 90 days of your last day worked. A withdrawal card will be issues provided all dues and financial obligations are paid and current; including dues for the month the withdrawal card is issued.

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