QUALIFIED DOMESTIC RELATIONS ORDER (QDRO)

1 Page 1 of 2 ORDER #204773 03/01/2019 TM: PLNWTHEAS/PWEPPWKQUALIFIED DOMESTIC RELATIONS ORDER ( qdro )2. GENERAL INFORMATIONS ubmission of this completed form along with the required supporting documentation identified below will facilitate our servicing of your transaction request. Please mail or fax your paperwork to the following:Regular Mail: Overnight Mail: Box 5054 2000 21st Ave NW Minot, ND 58702 Minot, ND 587021. COMPLETED FORM3. PARTICIPANT & PLAN INFORMATION (Please type or print clearly.)Participant Name (first, middle initial, last) Plan Name (the Plan ) Plan # A DOMESTIC RELATIONS ORDER ( DRO or ORDER ) is a court ORDER , judgment, or decree issued under a state s DOMESTIC RELATIONS law that recognizes the right of a spouse, former spouse, child, or other dependent of a Participant in an employee benefit plan to receive all or part of the Participant s benefit in the QUALIFIED DOMESTIC RELATIONS ORDER ( qdro ) is a DRO that has met the specific requirements mandated by federal law and the provisions of the plan as determined by the Plan Administrator or its designee.

2 A qdro requires a QUALIFIED plan to pay all or any part of a Participant s benefits to an Alternate Payee. An Alternate Payee is a spouse, former spouse, or dependent of the Participant who is entitled to a portion of the Participant s benefits. In ORDER to submit your DOMESTIC RELATIONS ORDER (DRO) to for approval, please complete the information requested in the space below and submit it along with your DRO paperwork to note: This ORDER must be a signed document of the court to be considered valid as will NOT review a draft that is not signed by the court. Additional Information: If forms and any other supporting documentation are not received in good ORDER , an e-mail will direct you to review the missing requirement(s) and resubmit the corrected form and/or additional information required. Please pay close attention to the acceptable documentation required to ensure your request can be completed in a timely the DRO is determined to be a qdro , the account(s) it will be placed in a pending status (Administrative Hold) for review and the Participant will not be able to take a distribution from the account(s) impacted until the qdro is processed and is notified by the investment provider(s) the funds to the Alternate Payee have been DOCUMENTATION/REQUIREMENTSIn ORDER for a Participant s benefit to be assigned to an Alternate Payee ( , the spouse, former spouse, child or other dependent of the Participant), a DRO that constitutes a qdro within the meaning of Internal Revenue Code Section 414(p) must contain the required elements as outlined below, to meet these, as well as s good ORDER requirements.

3 For more detailed information, you may reference IRS Notice The ORDER must include language that clearly creates or recognizes the right of the Alternate Payee (spouse, former spouse, child or other dependent of the Participant) to receive all or a portion of the Participant s plan account. Page 2 of 2 ORDER #204773 03/01/2019 TM: PLNWTHEAS/PWEPPWK4. DOCUMENTATION/REQUIREMENTS (continued)Voya Retirement Insurance and Annuity Company, One Orange Way, Windsor, CT 06095-4774, provides these plan administration services under the trade name . services may not be available in all The ORDER must provide the following Participant information: Name (full legal name) Social Security Number1 Last known mailing address Date of Birth1If state or local law prevents the inclusion of such information in the ORDER , this data must be provided to in a letter and/or addendum, signed by the attorney that drafts the The ORDER must provide the following Alternate Payee2 information: Name (full legal name) Social Security Number1 Last known mailing address Date of Birth1If state or local law prevents the inclusion of such information in the ORDER , this data must be provided to in a letter and/or addendum, signed by the attorney that drafts the the Alternate Payee is a minor child, the name of the Custodial Parent is needed in the The ORDER must include the investment provider name(s) and contract number(s).

4 If there are multiple investment providers and contracts awarded to the Alternate Payee, will need to have the exact percentage or amounts listed from each investment provider and contract The ORDER must include the amount or percentage of the Participant s account balance that must be paid to the Alternate Payee(s) or the manner in which the amount or percentage is to be calculated, including exact date to be used to determine the Alternate Payee s benefit. NOTE: All outstanding loan balances will be included in determining the Alternate Payee s benefit, unless specified otherwise. If the Alternate Payee is entitled to gains/losses, the ORDER must state how the gains or losses are calculated. 6. If applicable, the ORDER must specify the number of payments or period to which the DRO The ORDER must clearly and unambiguously name the Plan to which the ORDER applies.

5 The ORDER must reflect the full plan name as stated within the plan If applicable, the ORDER must indicate whether the Participant s vested account balance is to be used in determining the Alternate Payee s note: The Alternate Payee s right to receive a lump sum withdrawal or to roll over all or part of the account to a vendor under an eligible retirement plan may be limited by the Plan document and/or the Investment Provider(s) contract In addition to meeting these criteria, the ORDER may not alter the amount, form, or other provisions of benefits otherwise payable under the Plan(s). In other words, the ORDER must: The ORDER must not require a Plan to provide any type or form of benefit, or any option not otherwise provided under the Plan; The ORDER must not require the Plan to provide increased benefits (determined on the basis of actuarial value); The ORDER must not require the payment of benefits to an Alternate Payee that are required to be paid to another alternate payee under another ORDER previously determined to be a qdro .