Attachment B To Schedule Mp - Missing Participant Individual Information Page 2

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Attachment B • Page 2
Missing Participant’s Social Security No.
3a
(continued)
Yes
No
Is any part of the Missing Participant’s designated benefit amount attributable
to mandatory employee contributions? If “Yes” complete (1)-(3) below (if “No,” go to 3b).
(1) Relating to this filing
(2) Total for all filings
(1) Mandatory employee contributions that fund a portion of the Missing Participant’s
$
$
accrued benefit under the plan,
$
$
(2) Interest credited on those contributions to the deemed distribution date
$
$
(3) The total of (1) and (2). The amount in 3a must not be less than this amount.
3b
Other amounts due, if any.
Complete (1) if any additional amount is due to PBGC for voluntary employee contributions.
Complete (2) if any amount is due to PBGC for the Missing Participant’s share of residual
assets.
(1) Voluntary employee contributions and earnings
$
$
(a) Voluntary employee contributions held in a separate account.
$
$
(b) Earnings credited on contributions in (a) to the date sent to PBGC.
$
$
(c) Total of (a) and (b).
(d) If the amount entered in (1)(c) is not zero, enter the date voluntary contributions
(MM/DD/YYYY)
sent to PBGC.
(2) Residual assets and earnings
(a) The amount, if any, of residual assets due to PBGC based on a
$
$
Missing Participant’s share of residual assets.
$
$
(b) Earnings on residual assets to the date you pay PBGC.
$
$
(c) Total of (a) and (b).
(d) If the amount entered in (2)(c) is not zero, enter the date residual assets
(MM/DD/YYYY)
sent to PBGC.
(3) Total other amounts due, if any, to PBGC (line (1)(c) + line (2)(c)).
$
$
3c
Total amount due to PBGC (line 3a + line 3b(3))
Pay this amount
$
$

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