Retirement Plan Cryptocurrency Investment Policy Acknowledgment Form
Use this form to acknowledge your retirement plan cryptocurrency investment policy and indicate any follow-up needs.
Participant Information
Full Name
*
First Name
Middle Name
Last Name
Participant ID
*
Department / Team
Job Title / Role
Work Email Address
*
example@example.com
Retirement Plan Details
Retirement Plan Name
*
Plan Type
*
401(k)
403(b)
457(b)
Other
Plan Administrator or Provider Name
Cryptocurrency Investment Awareness
Do you currently hold any cryptocurrency-related investment option in your retirement plan?
*
Yes
No
Not sure
Have you reviewed the organization’s cryptocurrency investment policy?
*
Yes
Partially
No
What is your intended next action after reading the policy?
*
Continue as is
Review plan options
Discuss with advisor/HR
Reconsider crypto exposure
Other
Policy Acknowledgment and Agreement
Signature
Questions, Exceptions, and Follow-Up
Do you have any questions or need follow-up?
*
Yes
No
Preferred follow-up method
Please Select
Email
Phone
Meeting
No follow-up needed
Comments or questions
Acknowledgment date
*
 -
Month
 -
Day
Year
Date
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: