Sample Domestic Relations Order Forms

Note: The employer's retirement plan requirements must be followed or your domestic relations order will be denied. You should view the employer's model language form and consider using a similar structure. Get the employer's procedures (requirements) and model language forms on this site or contact us.

Below are sample domestic relations orders. However, do not use the samples as an actual domestic relations order.

Sample Defined Contribution Form (PDF, 67 KB)
Sample Defined Benefit Form (PDF, 50 KB)

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Creating a Domestic Relations Order
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