Manage Participant

Employee: JOHN CUSTOMER (XXX-XX-0003)

Products

Select products for which the employee does, or will, meet plan eligibility requirements to participate.

Employee data will be saved under each of the selected products.

Employee Data Applies to:

3-97011 - SAMPLE GROUP DEFINED CONTRIBUTION PLAN

7-06251 - SAMPLE GROUP PLAN

Required

Name

Last

First

Street address

City

State

ZIP

Work phone

Home phone

Work email

Social security number

Other employee ID

Date of birth

Date of employment (most recent)

Marital status

Marital status as of

Gender

Male

Female

Preferred Language

English

Spanish

Location

Yes! Contact this employee about consolidating retirement savings.

Type	Beginning date	Ending date	Military re-employment rights?	Action
Employment	01/01/1982	10/01/2006		Terminate employment

I confirm the information above and authorize Principal Life Insurance Company to process this request.