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PDF Fillable/saveable: FL-VB4 (size 1.8 Mb)
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Last Update: January 2021
Form No.: PF-115E
Title: Statement of Family Law Value - Variable Benefit Account (FSRA Family Law Form FL–VB4)
Purpose of Form:
This Form is to be used by the plan administrator to provide the retired member and their spouse the Family Law Value of the variable benefit account upon receipt of a completed Application for Family Law Value – Variable Benefit Account (FSRA Family Law Form FL–VB1).
Instructions on How to Use the Form: Instructions are included in the form.