Military Pension Division Order Form
Service Member Information
Full Name
*
First Name
Last Name
Social Security Number
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Former Spouse Information
Full Name
*
First Name
Last Name
Social Security Number
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of marriage
*
-
Month
-
Day
Year
Date
Date of judgment of divorce/separate maintenance
-
Month
-
Day
Year
Date
On what date did the service member enter service?
*
Branch of service (specify if in guard or reserve)
*
Current rank
*
Rank at time of judgment of divorce/separate maintenance
*
On what date was this rank attained?
*
Is the service member retired?
*
Yes
No
If retired, what was the date of retirement?
-
Month
-
Day
Year
Date
If retired, is the service member receiving retired pay yet?
Yes
No
If retired, provide a copy of DD Form 2656 (Application Upon Retirement) completed by service member at retirement
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If retired, provide a copy of a recent Retiree Account Statement (RAS)
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If retired, did the service member elect to participate in the Survivor Benefit Plan (SBP)?
Yes
No
If the service member elected to participate in the SBP, what election was made at retirement?
If the service member is no longer in the service, on what date did the Service member separate from service?
-
Month
-
Day
Year
Date
Is the service member collecting military disability benefits?
*
Yes
No
Unknown
Is the service member in the Blended Retirement System?
Yes
No
Has the service member elected to receive payment under the CSB/REDUX option?
Yes
No
If so, provide documentation of the election
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Has the service member elected to receive payments under the Voluntary Separation Incentive (VSI) or Special Separation Bonus (SSB) Programs?
Yes
No
If so, provide documentation of the election and payments
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If the service member is not retired, provide a copy of a recent leave and earnings statement (LES) **NOTE- In most cases we will require you to provide LES’s for the 36-month period immediately preceding the date of divorce
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If the service member served or is serving in the guard/reserve, provide a current chronological statement of retirement points
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If in the guard/reserve did the service member receive his or her "20-year letter?"
Yes
No
If so, attach a copy of the letter as well as a copy of the written election (if any)made with regard to participation in the Reserve Component SBP
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Has the service member previously been divorced?
Yes
No
If so, was the former spouse from the prior marriage awarded SBP coverage?
Yes
No
Does the service member also participate in the FERS or CSRS civilian government pension plan?
Yes
No
Has the service member contributed to the Thrift Savings Plan for Uniformed Services?
Yes
No
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