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Forgo Receipt of Benefits

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As outlined in PBGC Regulations 4041.2 and 4041.21(b)(2) of the Code of Federal Regulations, a majority owner may forgo the receipt of benefits to facilitate plan termination. The enclosed form serves as an example and, pending adoption by your legal counsel, may provide elements for consideration. Please note that this example is not intended for direct use as a legal document and should not replace formal legal advice.

You may link your resources to this webpage for prefilling the form below. For example, Example Custom Link. This is generally done in Excel's =Hyperlink() but other resources may be used to combine your data for completing this form quickly.

Notice Inputs

Plan Name

Plan Number

Plan Administrator

Admin Phone

Admin Email

Admin's Address

Employer

EIN

Notice Date

Participant

Forgo Receipt of Benefits Election

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