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NAPUS Form 1187

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

SECTION A - All New Members Complete
Your title determines whether you also complete Section B or C

Social Security Number Date of Birth

Gender

Male_____Female_____

Home Telephone

(          )

Name of Employee (PRINT Last, First, Middle) Nick Name:
Home Address (Street and Number / P.O. Box)                                 City State                                                ZIP + 4
Spouse First Name: Personal E-Mail Address:

SECTION B - Postmasters Only Complete

Post Office City / State                     ZIP Code                                                    Post Office Finance Number
Post Office Level Postmaster's Direct Post Office Telephone
               (          )

SECTION C - Officers-in-Charge / Associates Only Complete

Post Office City / State PO Finance Number of OIC Detail
Date of PM / OIC
Appointment		 Post Office Telephone
Number ( )
Former Postmaster at this Office has     o Retired Date          /         /            o Detailed to      (Title and Location)
Home Payroll Office Finance Number: Employee Designation Code:

SECTION D - For Use by the Employee Organization

P

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		 o NAPUS Membership Chair
o NAPUS Chapter Secretary - Treasurer		 Date

SECTION E - Authorization by Employee

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 of the 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 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 payroll office of my employing agency. I further understand that revocation forms-Standard Form No. 1188, "Revocation of Voluntary Authorization for the Allotment of Compensation 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 with the payroll office of my employing agency. Such revocation will not be effective, however, until the first full pay period following March 1 or September 1 of my calendar year, whichever date first occurs after the revocation is received in the payroll office.

Signature of Employee Date
(Optional) I was personally contacted by ________________________________________________ about joining NAPUS.

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