(Q)DRO Order Form Please complete the following form to begin the process Step 1 of 7 14% 1. Client InformationPlease enter the personal information for each party involved.Client OneName(Required) First Last Position in Case(Required) Plaintiff/ Petitioner Defendant / Respondent Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth(Required) MM slash DD slash YYYY Social Security Number(Required)Email(Required) Phone(Required)Client TwoName(Required) First Last Position in Case(Required) Plaintiff/ Petitioner Defendant / Respondent Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Birth(Required) MM slash DD slash YYYY Social Security Number(Required)Email(Required) Phone(Required) 2. Marriage InformationPlease enter the important dates below. Date of Marriage(Required) MM slash DD slash YYYY Date of Commencement MM slash DD slash YYYY The date the divorce was filedDate of Divorce MM slash DD slash YYYY If divorce has been finalized Enter Each Plan Individually <div class="repeater-field-header"> <div class="repeater-field-header-title"> <span class="repeater-field-header-count">1</span></div> <div class="repeater-field-header-acctions"> <ul> <li><i class="repeater-icon icon-down-open repeater-field-header-acctions-toogle" aria-hidden="true"></i></li> <li><i class="repeater-icon icon-cancel-1 repeater-field-header-acctions-remove" aria-hidden="true"></i></li> </ul> </div> </div> Plan To Be DividedINSTRUCTIONS: Please enter all the plans that are to be divided as part of your divorce. Defined Contribution Plans include: 401(k), 403(b), 401(a) 457, TSP, TDA, Profit Sharing, and ESOP Public Defined Benefit Plans include: Pensions, Money Purchase Plans, and Cash Balance Plans Government or State Pensions are any Defined Benefit Pension that is issued by: Federal, State or Local Governments, and Churches IRAs are Individual Retirement Accounts. These include Tradition IRAs and ROTH IRAs. NOTE: These types of account typically do not require a QDRO. Select "Add Another Plan" to add additional plans.Plan Type(Required)Defined ContributionDefined Benefit PlanGov't or State PensionLegal Name of PlanPlan Participant Name(Required) First Last This is the person whose name is on the accountEmployer Name(Required)Name of employer where plan is heldStart Date of Employment(Required) MM slash DD slash YYYY Last Date of Employment MM slash DD slash YYYY Leave blank if still employed with this employerPlan Administrator (If Known)Plan Administrator Phone Number (If Known)How is this plan to be divide?(Required) Percentage Fixed Amount Other Please enter the percentage, dollar amount, or "other" below(Required)Should a proportionate share of market gains and losses from the valuation date to the date of actual segregation be included in the amount awarded to the alternate payee?(Required) Yes No This information can be found in your agreement.Should loan balances, if any, be included or excluded in the total account balance when determining the Alternate Payees awarded portion of benefits?(Required) Included (Select if no loans exist) Excluded Included = the alternate payee's share is not reduced from the loan Excluded = the alternate payee's share is a share of the account value not including the loanPre-Retirement and Survivorship Benefits (Pensions Only)(Required) Include a proportionate share of early retirement subsidies Include a proportionate share of post retirement subsidies (N/A) This is not a Pension Administrative fees charged by the plan should be paid from(Required) The Participants Account Only The Alternate Payee's Share Only Shared Equally by the Participant and Alternate Payee Select "Add Another Plan" to enter additional plans or "Next" to continue Additional parties to be included in future QDRO correspondenceIf you would like Divorce Logic to include your attorney on all correspondence, please add their information. Client One:Attorney's name or name of Law FirmAttorney's Phone NumberAttorney's Email Client Two:Attorney's name or name of Law FirmAttorney's Phone NumberAttorney's Email Documents to uploadPlease upload: Marital Settlement Agreement, Stipulation of Settlement, or Judgement of Divorce. + Recent Statement(s) from plan(s) to be divided Drop files here or Select files Max. file size: 100 MB. (Q)DRO Service Disclosure AgreementI (we) certify that the information provided above is accurate to the best of my (our) knowledge and ability. I (we) certify that the information above is provided consistent with the intent and integrity of the marital settlement agreement, stipulation of settlement or signed divorce decree. I (we) are aware that Divorce Logic LLC, LLC is a preparation service only. Divorce Logic LLC, LLC is not a law firm and does not provide legal advice. Please consult your attorney regarding any legal concerns. Divorce Logic LLC is not legally permitted to file the QDRO with the courts on your behalf. In providing the services under this agreement it is expressly agreed that Divorce Logic LLC, is acting as an independent contractor and this agreement is exclusively a contract for service. It is understood and agreed to that Divorce Logic LLC, LLC will not be liable to the customer, or any agent or associate of the customer, for any mistake or error in judgment or for any act or omission done in good faith and believed to be within the scope of authority conferred or implied by this Agreement. The Parties agree to do everything necessary to ensure that the terms of this Agreement take effect. Electronic Consent(Required) I have read and agree to the termsPlease Type Your Name(Required)Client One Total Amount DuePlease complete the options below to calculate the total amount dueDivorce Logic LLC will not begin to process your request until payment is made. Defined Contribution Plans Quantity(Required) Price: $700.00 Quantity Public Defined Benefit Pensions Quantity(Required) Price: $800.00 Quantity Public pensions are NOT Gov't pensionsGov't Defined Benefit Pensions Quantity(Required) Price: $900.00 Quantity IRA and ROTH IRAs Quantity(Required) Price: $800.00 Quantity Grand Total Completed. Please click "Submit" to create your order.Payment instructions will be included on the next screen.CommentsThis field is for validation purposes and should be left unchanged. Δ
