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Census Questionnaire

Our Census Questionnaire is available online – on a secure connection – for your convenience. You can easily fill out the form below. However, if you are more comfortable with downloading the Census Questionnaire in PDF format and submitting by fax, please feel free do so by clicking here. Our fax number is 407-875-0189.

    Plan Sponsor Name
    Plan Year End
    If this Plan covers employees of more than one company, please give the data for each company.
    Names of Officers or Partners Who are Employees


    Titles


    Names of Stockholders/Partners Who are Employees


    % of Stock/Partnership interest owned


    Are there other businesses, incorporated or not, owned by this business or the owners of this business? Is this an affiliated service group?
    YesNo
    Please list the names of any employees who are related to stockholders.
    Name


    Relationship


    Related to Whom


    Fiduciary Surety Bonding Information
    Name of Insurance Company
    Amount of Bond
    Did you, or a business you control, maintain any other qualified plan (including frozen plans) for which Pension Investors Corp. does not provide services?
    YesNo
    If Yes, explain:
    Are there shared or leased employees?
    YesNo
    Completed By
    Title
    Date Completed