Pension Transfer Agreement Form

PENSION TRANSFER AGREEMENT FORM

This Pension Transfer Agreement (the "Agreement") is made and entered into on by and between Transferor Name: (hereinafter "Transferor") and Transferee Name: (hereinafter "Transferee"). Transferor and Transferee are referred to collectively as the "Parties."

RECITALS

WHEREAS, Transferor is a participant or beneficiary in the pension plan identified as Plan Name: , Member/Participant ID: ; and

WHEREAS, Transferee is the administrator or designated receiving plan identified as Receiving Plan Name: , Receiving Plan Administrator: ; and

WHEREAS, the Parties desire to transfer certain vested pension benefits of the Transferor from the Transferor's current plan to the Transferee subject to the terms and conditions set forth below.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, the Parties agree as follows:

1. DEFINITIONS

1.1 "Accrued Benefit" means the vested benefit described in Schedule A and any ancillary rights attributable to that benefit. 1.2 "Effective Date" means the date on which the transfer is recorded by the Transferee as set forth in Section 3. 1.3 "Plan" means the pension arrangement identified in the Recitals unless otherwise specified.

2. TRANSFER OF BENEFITS

2.1 Transfer. Subject to the terms of this Agreement, Transferor instructs the Transferor's current plan administrator to transfer the Transferable Benefits to the Transferee for the benefit of the Transferor in the form specified below. The Parties agree that the transfer shall consist of:

Entire accrued and vested benefit described in Schedule A

Specified amount: $ (to be transferred and actuarially converted as necessary)

2.2 Effective Date. The Parties anticipate that the Effective Date of transfer shall be , subject to calculation and administrative processing.

3. CALCULATION, SETTLEMENT AND PAYMENT

3.1 Calculation Method. The transferred value shall be determined in accordance with the actuarial assumptions and conversion factors used by the Transferor's plan as of the valuation date: . Any rounding, expenses, or fees to be deducted shall be disclosed to both Parties in writing prior to remittance.

3.2 Method of Transfer. Payment shall be made by one of the following: direct trustee-to-trustee transfer, check made payable to the receiving plan's trustee, or electronic funds transfer as agreed by the plan administrators. Receiving Plan EIN: . Receiving account/reference:

4. PROCEDURAL OBLIGATIONS

4.1 Cooperation. Each Party shall cooperate in good faith and provide all reasonably requested documentation to effect the transfer, including but not limited to certified plan records, benefit statements, participant consents where required, and notarized authorizations.

4.2 Timing. The Transferor's plan administrator shall use commercially reasonable efforts to remit the transfer within days after completion of required calculations and receipt of all documentation.

5. REPRESENTATIONS AND WARRANTIES

5.1 Transferor represents and warrants that: (a) Transferor is the entitled party to the benefits described in Schedule A; (b) Transferor's representations in any enrollment or benefit forms are true and complete; and (c) there are no outstanding lien, assignment, or legal process that would prevent the transfer except as disclosed in writing to Transferee.

5.2 Transferee represents and warrants that: (a) it is authorized to accept the transferred benefits for the benefit of the Transferor; (b) it will hold and administer the transferred assets in accordance with applicable law and the terms of the receiving plan; and (c) it will promptly notify Transferor of acceptance or rejection of the transfer.

6. TAX, REPORTING AND COMPLIANCE

6.1 Tax Consequences. The Parties acknowledge that tax consequences may arise from the transfer. Each Party shall be responsible for its own tax reporting and liabilities arising from the transfer, except as otherwise required by applicable law or agreed in writing.

6.2 Regulatory Compliance. Each Party shall comply with all applicable statutory, regulatory and plan requirements necessary to effectuate the transfer, including required notices to beneficiaries and government filings where applicable.

7. INDEMNIFICATION

7.1 Each Party agrees to indemnify, defend and hold harmless the other Party and its respective officers, trustees, administrators and agents from and against any losses, claims, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of any breach of this Agreement, misrepresentation, or failure to comply with applicable law by the indemnifying Party.

8. CONFIDENTIALITY

8.1 The Parties shall maintain as confidential all non-public information exchanged in connection with this transfer and shall use such information solely for the purpose of effectuating the transfer, except as required by law or necessary to obtain regulatory approvals.

9. NOTICES

Notice to Transferor

Notice to Transferee

Notices shall be deemed given when delivered by hand, sent by nationally recognized overnight courier, or three business days after deposit in the mail with first-class postage prepaid to the addresses provided above, or as otherwise designated in writing by either Party.

10. MISCELLANEOUS PROVISIONS

10.1 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction of , without regard to its conflicts of law principles.

10.2 Entire Agreement. This Agreement, together with any schedules or attachments expressly incorporated herein, constitutes the entire agreement between the Parties with respect to the subject matter and supersedes all prior negotiations, representations or agreements, whether written or oral.

10.3 Severability. If any provision of this Agreement is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed only to the extent necessary to make it enforceable.

10.4 Amendments; Waiver. No amendment, modification or waiver of any provision of this Agreement shall be effective unless in writing and signed by both Parties. A waiver of any breach shall not constitute a waiver of any subsequent breach.

10.5 Counterparts. This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Signatures transmitted by facsimile or electronic image shall be deemed original signatures for all purposes.

SCHEDULE A — DESCRIPTION OF TRANSFERABLE BENEFITS

ADMINISTRATIVE CONTACTS

Transferor Administrative Contact

Transferee Administrative Contact

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