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The information requested in this Form provides the basic information needed with regard to a company so that LDSCO can prepare a qualified plan Proposal that best suits the company's needs.

Enter the Principal Name of the company's representative that is authorized to provide information regarding the pension plan. Provide the appropriate Business Address and Telephone# as requested.

The Taxpayer ID# is the Employer Identification Number assigned to the Company by the Internal Revenue Service.

The Fiscal Year End and Type of Entity assists LDSCO in accurately applying a company's facts to the data contained in the Proposal.When completed, this form can be E-Mailed to LDSCO. A Census Diskette is available upon request. Please contact your Pension Consultant via E-Mail or by Telephone.