Form 8955-Ssa Annual Registration Statement (Page 2 of 2) in pdf

Form 8955-Ssa Annual Registration Statement Page 2

1807

Form 8955-SSA (2015)

Page 2 of 2

Page 2.1

Name

Plan Number

EIN

of plan

PART III

Participant Information - enter all requested information

9 Enter one of the following Entry Codes in column (a) for each separated participant with deferred vested benefits who:

Code A

—

has not previously been reported.

Code B

—

has previously been reported under the above plan number, but whose previously reported information requires revisions.

Code C

—

has previously been reported under another plan, but who will be receiving benefits from the plan listed above instead.

Code D

—

has previously been reported under the above plan number, but whose benefits have been paid out or who is no longer entitled to those deferred vested benefits.

Use with entry code "A", "B", "C", or "D"

Use with entry code "A" or "B"

Entry code "C" only

Enter code for nature

(b)

Amount of vested benefit

(h)

(i)

(

c) Name of Participant (See instructions.)

(a)

and form of benefit

Social Security

Entry

(f) Defined

(g) Defined contribution

Number

sponsor’s

plan

(d) Type of

(e) Payment

Code

benefit plan —

plan — total value

First name

M.I.

Last name

(or FOREIGN)

EIN

number

annuity

frequency

periodic payment

of account

Form 8955-SSA (2015)

Form 8955-Ssa Annual Registration Statement Page 2

Related Articles

Related forms

Related Categories