MP-300 Template MP-300 Template

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Overview

Instructions
Schedule A
Schedule B

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Sheet 1: Instructions

	Instructions for Using Excel Template
1.	Review the Form MP-300 instructions before entering data.
2.	Overwrite the sample data shown with the data that needs to be reported.
3.	Delete the non-applicable tab from the spreadsheet (i.e., Transferring Plans delete the Schedule A tab; Notifying Plans delete the Schedule B tab).
4.	Enter the PBGC case number assgined to your plan in the heading of the applicable tab.
5.	Save your spreadsheet as "Form 300 Excel Attachment_12345600" where "12345600" is the applicable case number of your plan.
6.	Feel free to add a row at the bottom totalling amounts, counting participants, etc., but please insert a blank row between the individual data and any "total" row you want to add.

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Sheet 2: Schedule A

Schedule A individual data - Attachment to Form MP-300

See instructions for detailed information about data to be entered, including information about which items may be left blank

Case Number

12345600

Part I - Financial Institution Information

Part II - Individual Information

Company Name

Contact Name

Contact Telephone

Contact Email

Street

City

State

Zip

Missing distributee's name

Date of birth

Social security number (enter w-o dashes)

Last-known address

Accrued benefit information

Account/Certificate number

Amended Filing Code

Last

First

Middle

Street

City

State

Zip

Amount

If monthly, enter MB. If current value, enter CV

2a

2b(1)

2b(2)

2b(3)

2c(1)

2c(2)

2c(3)

2c(4)

3a(1)

3a(1)

3a(1)

3a(2)

3a(3)

3b(1)

3b(2)

3b(3)

3b(4)

3c

3c

3d

4

Annuties-R-Us

Geraldine Williams

800-555-1111

[email protected]

52 Bluebird Drive

Newark

NJ

07101

White

Betty

E

5/5/1955

111111111

123 Robin Hwy Ave

City1

DE

42345

$35,000.00

CV

1111111

Annuties-R-Us

Geraldine Williams

800-555-1111

[email protected]

52 Bluebird Drive

Newark

NJ

07101

Yellow

Joseph

F

6/6/1965

222222222

123 Blackbird Rd

City2

WV

52345

$150.00

MB

2222222

Annuties-R-Us

Geraldine Williams

800-555-1111

[email protected]

52 Bluebird Drive

Newark

NJ

07101

Black

Polly

G

7/7/1970

333333333

123 Eagle St

City3

DE

62345

$50.00

MB

3333333

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Sheet 3: Schedule B

Schedule B individual data - Attachment to Form MP-300

See instructions for detailed information about data to be entered, including information about which items may be left blank

Case Number

12345600

Part I - Identifying Information

Part II - Amount Owed to PBGC

Part III - Missing Participant Benefit Information

Missing distributee's name

Date of birth

Social Security Number (enter w-o dashes)

Last-known address

Other name(s) ever used

Type of distributee

Prior payments (Yes or No)

Non-U.S. Source Income (Yes or No)

Employee contributions (Yes or No)

Amended filing code

Benefit transfer amount @ BDD

Administrative fee (if applicable)

Late payment

Lump sum eligibility (Yes or No)

Normal retirement date

Monthly SLA @ BDD

Monthly Single Life Annuity payable at various ages

Last

First

Middle

Street

City

State

Zip

P if Participant B if Beneficiary

Amount

Interest

Age 55

Age 56

Age 57

Age 58

Age 59

Age 60

Age 61

Age 62

Age 63

Age 64

Age 65

NRD (or accrual cessation date, if later)

2a

2a

2a

2b

2c

2d(1)

2d(2)

2d(3)

2d(4)

2e

2f

2g

2h

2i

2j

3

4

5a

5b

6

7

8a

8b

8b

8b

8b

8b

8b

8b

8b

8b

8b

8b

8b

White

James

E

5/5/1955

111111111

123 Robin Hwy Ave

City1

DE

42345

P

No

No

No

$35,000.00

$35.00

$0.00

$0.00

Yes

6/1/2020

$318.00

$175.00

$192.50

$210.00

$227.50

$245.00

$262.50

$280.00

$297.50

$315.00

$332.50

$350.00

$350.00

Yellow

Joseph

F

6/6/1965

222222222

123 Blackbird Rd

City2

WV

52345

P

No

No

No

$10,000.00

$35.00

$0.00

$0.00

No

7/1/2030

$0.00

$50.00

$55.00

$60.00

$65.00

$70.00

$75.00

$80.00

$85.00

$90.00

$95.00

$100.00

$100.00

Black

Polly

G

7/7/1970

333333333

123 Eagle St

City3

DE

62345

B

No

No

No

$150.00

$0.00

$0.00

$0.00