Lexington Pension Consultants, Inc:

ONLINE ORDER FORM

Complete the below to the best of your ability. Note, each QDRO and/or Pension Valuation requires a separate case. E.g., if you need to divide three retirement plans, you will be opening three separate cases; if you need two plans/accounts valued, you will be opening two separate cases. You will have the ability to upload case documents at the end of this online process.

If you are an existing Lexington Pension Consultants, Inc. client, we suggest that you log in prior to starting this form. This will save you time. If you do not know your username or password, please call us at 718-697-0100.

* = required field

Case Details

Email Address of the person completing this form *

If you want a copy of this form to go to another person, include the email address below

Case Name/Caption (e.g. Smith v. Smith)*

Current Marital Status

Sharing Level

Mutually retained

(jointly retained and information is to be shared with both attorneys/parties)

Share information

(not jointly retained but have permission to discuss this matter and/or share documents with the opposing attorney/party)

Do not share

(do not have permission to discuss this matter with the opposing attorney/party)

Court ordered

(please provide a copy of the Court Order)

Mediation

Requesting Attorney/Requesting Pro Se Information

Name*

Firm Name

Address

Phone*

Fax Number

(For Attorneys) Your Client is

Check this box if you are a Pro Se and are not working with an Attorney.

Opposing Attorney/Opposing Pro Se Information

Name

Firm Name

Address

Phone

Fax Number

Check this box if the opposing party is a Pro Se and is not working with an Attorney.

Court Information

Judge's Name

County

State

Index/Docket Number

Plaintiff's/Petitioner's Information

Plaintiff/Petitioner Name*

Address

Sex

Social Security Number

D.O.B

Defendant's/Respondent's Information

Defendant/Respondent Name

Address

Sex

Social Security Number

D.O.B

Important Dates

Date Married

Date of Divorce (if applicable)

Date of Stipulation

Divorce Commencement/Summons Date

Next Court Appearance Date (if applicable)

Add Pension/Participant Information

Requested Service*

Plan Name*

Plan Participant's Name*

Plan Address

Plan Contact Person

Plan Phone Number

Plan Participant is:*

Marital Asset Cutoff Date

Plan Entry Date

Date Retired/Terminated

Year of Hire

Year of Retirement/Term.

Employer/Union

Job Title

Employee No.

Employment Status

Tier (if applicable)

If Retired & in Pay Status, is Pension Finalized?
YES NO

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