Request for Proposal


Targeted Individuals or Groups

What do you expect to accomplish by setting up this plan?

Affiliated Companies

Company Name

Owner 1 / % Own

Owner 2 / % Own

Owner 3 / % Own

Owner 4 / % Own

Owner 5 / % Own

Referred by

Asset Manager


*List the 5 largest owners of the employer and the percentages of ownership for each owner.

**The amount of money that will be contributed by the employer exclusive of employee contributions.
If a range of contributions is needed, enter the range.


Complete the attached census form so that we may analyze the employer and provide options tailored to
this employer.

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