Sample Transmittal Letter Dear Plan Administrator:

Enclosed please find an authorization form signed by Social Security Numberthat grants you permission to disclose information relative to Mr./Ms ’s retirement benefit programs under which he/she may be covered as a result of his/her employment with your company.

Please provide us with the following information:

A. ALL QUALIFIED AND/OR NONQUALIFIED RETIREMENT OR DEFERRED COMPENSATION PLANS:

The names of all of the qualified retirement plans under which Mr./Ms. participates (or has participated ) or is currently accruing (or has accrued) benefits, including, but not limited to, any defined benefit pension plan or defined contribution plan (such as a 401(k), profit sharing, thrift, retirement savings, or ESOP stock option plans, excess defined benefit plans, or any other deferred compensation arrangement whether uninsured or insured.).

Plan Name:

Plan Name:

Plan Name:

B. ALL OTHER PLANS, INCLUDING WELFARE BENEFIT PLANS:

The names of all other plans under which Mr./Ms. participates, including, but not limited to, your health plans (including cafeteria plans, managed care plans, HMOs, mail-order pharmacy plans, stand-alone vision plan), dental plans, short-term and/or long-term disability plans, and life insurance plans.

Plan Name:

Plan Name:

Plan Name:

C. STATEMENT OF ACCRUED BENEFITS AND/OR ACCOUNT BALANCES:

Please complete the following PENSION QUESTIONNAIRE for each retirement plan under which Mr./Ms.has earned a benefit.

Thank you for your help on this request. If you have any questions, please do not hesitate to contact me.


Sincerely,

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