QDRO Information Form
Please provide the required information to process your Qualified Domestic Relations Order (QDRO).
Participant's Full Name
*
First Name
Last Name
Participant's Email Address
*
example@example.com
Participant's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Payee's Full Name
*
First Name
Last Name
Alternate Payee's Email Address
example@example.com
Retirement Plan Name
*
Relationship of Alternate Payee to Participant
*
Spouse
Former Spouse
Child
Other
Type of Benefit/Division Requested
*
Please Select
Division of Defined Contribution Plan (e.g., 401(k), 403(b))
Division of Defined Benefit Pension
Other (please specify)
Additional Information or Instructions
Submit
Should be Empty: