Defined Contribution Qualified Plan Form

Case Name
Court
THE PARTIES
Participant (employee):
Full Name*
First Last
Current Mailing Address*
Street Address City State ZIP Code
Date of Birth
MM slash DD slash YYYY
Social Security Number
Telephone Number*
E-mail*
Alternate Payee (non-employee):
Full Name*
First Last
Current Mailing Address*
Street Address City State ZIP Code
Date of Birth
MM slash DD slash YYYY
Social Security Number
Telephone Number*
E-mail*
Attorney:
Full Name
First Last
Email
Phone
Please identify which party has sent in this form:*
- Participant
- Alternate Payee
- Attorney
Marital Information:
Date of Marriage
MM slash DD slash YYYY
Date of Divorce
MM slash DD slash YYYY
Formal Name of Plan
Plan Administrator:
Name of Plan Sponsor
First Last
Contact
Address
Street Address City State ZIP Code
Establishment of Alternate Payee Account
Describe amount/percentage, timing, investment return if defined contribution
Timing of Payment of Alternate Payee Account
Payout Timing
- Immediate Payout
- Deferred Payout
Type of Plan Valuation
- Daily
- Balance Forward
If Loan Outstanding
- Split to Alternate Payee
- Ignored
Please upload a copy of the decree, agreement incident to divorce and/or mediated settlement agreement, even if such document(s) are still in draft form.
Drop files here or

Max. file size: 2 GB.
Other Special Issues/Requirements
Credit Card
What Email address would you like to receive your payment receipt?*
Defined Contribution Qualified Plan
Total
$0.00

THE PARTIES