Pbgc Model Separate Interest Qdro printable pdf download

Pbgc Model Separate Interest Qdro

PBGC Model Separate Interest QDRO

(You may use this model when a defined benefit pension plan has terminated, PBGC has

become trustee of the plan, and the parties want PBGC to divide the value of the participant’s

benefit between the participant and the alternate payee. You may use this model only if the

participant’s benefit payments have not started when the order is submitted to PBGC for

qualification. Please read instructions for important information.)

In The

____________

COURT OF ______________

DIVISION ___________

COUNTY ______________

-----------------------------------------X

IN RE MARRIAGE/SUPPORT OF

__________________

PETITIONER,

CASE NO.

____________

__________________

PARTICIPANT, RESPONDENT.

-----------------------------------------X

QUALIFIED DOMESTIC RELATIONS ORDER

This Order is intended to be a qualified domestic relations

order (“QDRO”), as that term is defined in section 206(d) of

the Employee Retirement Income Security Act of 1974, as amended

(“ERISA”) and section 414(p) of the Internal Revenue Code of

1986,as amended (“Code”). This Order is granted in accordance

with [applicable state domestic relations law citations],

which relate to marital property rights, child support, and/or

spousal support between spouses or between a spouse and a former

spouse in matrimonial actions. The Participant is not currently

receiving benefit payments from PBGC with respect to the plan

identified below.

SECTION 1. IDENTIFICATION OF PLAN

This Order applies to benefits under the [formal name of plan]

(“Plan”). The Pension Benefit Guaranty Corporation (“PBGC”) is

trustee of the Plan.

SECTION 2. IDENTIFICATION OF PARTICIPANT AND ALTERNATE PAYEE

a. [Name of the Participant] is eligible to receive a benefit

from the Plan and is hereafter referred to as the “Participant.”

The Participant’s mailing address is [address]. The Participant’s

Social Security Number is [Social Security Number].

PBGC Model Separate Interest QDRO

Pbgc Model Separate Interest Qdro