PENSION RETIREMENT PLAN FORM
It is important that you complete ALL information on this form. Failure to do so may delay our ability to prepare your order.
Name of person completing this form
*
First Name
Last Name
Participant/Employee
*
First Name
Last Name
Retirement Plan Name
Employer/Former Employer
*
Employee Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Hire Date
/
Month
/
Day
Year
Date
Was the employee working for this employer prior to the marriage?
*
Yes
No
Type of Employee
*
Hourly
Salary
Is the employee still working for this employer?
*
Yes
No
If not still working for employer, when did employment cease?
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Month
-
Day
Year
Date
Is the employee receiving monthly pension benefits?
*
Yes
No
If the employee is receiving benefits, when did the pension benefits commence?
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Month
-
Day
Year
Date
If not clearly specified in the divorce judgment/settlement agreement, and if allowed under the plan, is the employee's former spouse permitted to receive his or her share of the employee's pension at any time the plan allows, even if the employee has not retired?
Yes
No
If not clearly specified in the divorce judgment/settlement agreement, what is the intended date on which the benefit awarded to the former spouse is to be calculated/divided?
/
Month
/
Day
Year
Date
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