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|Form title:||Family Law Form FL–4C: Statement of Family Law Value – Active Member of a Plan with Defined Benefit and Defined Contribution Provisions|
Family Law – Plan Administrators
|Purpose of form:||This form is to be used by a plan administrator to provide the family law value upon receipt of an Application for Family Law Value (Family Law Form FL–1), where the plan provides a separate defined benefit and defined contribution benefit to its members.|