Plan Amendment Service REQUEST

Plan Amendment Service Request

To request an amendment to your EPIC sponsored plan document, please complete and submit this form.
Date of request*

MonthDayYear
Contact Information
Plan Name*
Three character EPIC ID*
9 Digit EIN
##-#######
Plan Number (001, 002,....)
EPIC Bank/RIA Partner Name
Contact Name*
Contact e-mail*
example@example.com
Contact Phone Number*
Plan Amendment Details

Please fully describe/detail the amendment you wish to make to the plan document in the space provided below.
Amendment Effective Date:*

MonthDayYear
Description of Plan Amendment:
Plan Authorized Signer
Name*

First NameLast Name
Email*
example@example.com
Trustee(s)
List all (click + for additional trustees, if applicable)*
Name*

First NameLast Name
Email*
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Name

First NameLast Name
Email
example@example.com
Requestor Electronic Signature
Name*
Title*
Requestor E-Mail*
example@example.com
THANK YOU: Your request will be processed upon submission. We will contact you if we have any questions.
Recordkeeper Use Only
AM Name:
CSS Name:
Worklog:
Should be Empty:

Plan Amendment Service Request