Retirement Benefit Plan of American Airlines, Inc. for Flight Attendants

SENDER Information

Information about you and how we can contact you.
Your Name *

First Name Last Name
Your Email *
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Your Phone Number *

Area Code Phone Number
Your Client's Name *

First Name Last Name
Additional Information About the Employee
What is the Employee's American ID Number? *
What is the Employee's telephone number *
What is the Employee's E-Mail address? *
Information About the Non-Employee Spouse
Is the Non-Employee Spouse an employee of American Airlines? *
What is the Non-Employee Spouse's American ID Number? *
What is the Non-Employee Spouse's telephone number? *
What is the Non-Employee Spouse's E-Mail address??
Information About Your Retirement
Does the employee still work at the company? *

Yes No
Does the employee receive monthly payments for this retirement? *

Yes No
Are you dividing the entire retirement or just the community property portion? *
What percentage of the retirement will the non-employee spouse receive? *
Do you want to use the date of divorce as the valuation date? *
Please specify the valuation date. *
Will the non-employee spouse share early retirement? *

Yes No
Is there anything else we should know?
Please Review Your Answers Carefully

There is a $50 charge for every change after you submit these answers
PLEASE NOTE: Your QDRO will be prepared exactly as you instruct us on this form. There is a $50 charge for every change to the information or instruction you provide us. If you do not know how to answer a question, please consult with your lawyer before submitting your answers. If you do not have a lawyer, we will attempt to explain the question to you, but we cannot provide you with an answer. If the answers you provide us differ from the terms of your Divorce Decree, your QDRO may be rejected by the Court and changes will be necessary.
Should be Empty:

SENDER Information

Additional Information About the Employee

Information About the Non-Employee Spouse

Information About Your Retirement

Please Review Your Answers Carefully