Qualified Domestic Relations Checklist printable pdf download

Qualified Domestic Relations Checklist

____________________________________[insert name of plan]

QUALIFIED DOMESTIC RELATIONS CHECKLIST

Personal Information

Company Name

________________________________________________________________________

Participant Name

Participant’s Social Security #

________________________________________________________________________

Phone Number and E-Mail Address of Participant

________________________________________________________________________

Name of Putative Alternate Payee

Social Security #

________________________________________________________________________

Relationship of Putative Alternate Payee to Participant as specified in order

________________________________________________________________________

Answer each question with respect to the Order received.—If Any question is answered

No, the order should either be rejected or undergo further review.

Does the Order clearly state that it applies to this Plan?

Yes

If the name of the Plan as specified in the Order is incorrect, can the Plan

still clearly determine the plan to which it applies?

Yes

Does the Order clearly appear to have been issued by a court?

(If the Order is currently in draft form, answer based upon the manner in

which the Order is drafted, i.e., is the Order drafted to be signed by a court

of competent jurisdiction)

Yes

Qualified Domestic Relations Checklist