QDRO CHECKLIST (ERISA and Non-Qualified Plans)

 

Please fill out the checklist below and then submit for our review.

Alternatively, you can download the checklist here and corresponding release form here and then fax, email or mail, along with the applicable documents.

Fax: (281) 528-6113
Email: richardj@qdrosvc.com
Mail:
QDRO Services, L.L.C.
P.O. Box 1569
Spring, Texas 77383-1569

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Note: The use of the internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

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Instructions:
* (asterisk) indicates required fields.

Participant/Employee Information:

Name: *

Email: *

Phone: *

Address: *

City: *

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip: *

Social Security Number:

Date of birth: mm/dd/yyyy

Date of Employment: mm/dd/yyyy

Retired:

Yes No

Have Benefit Payments Commenced:

Yes No

Alternate Payee/Non-Employee Information:

Name:

Phone

Address:

City:

State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Social Security Number:

Date of birth: mm/dd/yyyy

Date of marriage: mm/dd/yyyy

Date of divorce: mm/dd/yyyy

Date of division
(if different from date of divorce): mm/dd/yyyy

Plan Information:

Company/Sponsor:

Name:

Phone:

FAX:

Plan Names:

a.

b.

c.

Please provide the indicated exhibits:*

1. Copies of latest plan statements. Very Important. 2. Copy of any pleading with style of case, case number, attorneys' names, addresses, phone, fax and State Bar numbers. 3. Copy of decree, judgment, agreement, Rule 11, etc. 4. Copy of latest retirement check information (if retired). 5. Please draft QDRO. Fee $
(Call or visit our website at www.qdrosvc.com for a fee schedule).

SPECIAL INSTRUCTIONS OR REQUESTS:

Attorney / Client's Name: *

Attorney / Client to be invoiced: *

Address to be invoiced: *

Transmit correspondence by e-mail to the following mailbox: *

NOTE: Fees are payable in advance prior to commencement of work.