APPENDIX C TO § 2578.1

## NOTICE OF PLAN TERMINATION

\[*Date of notice*\]

\[*Name and last known address of plan participant or beneficiary*\]

Re: \[*Name of plan*\]

Dear \[*Name of plan participant or beneficiary*\]:

We are writing to inform you that the \[*name of plan*\] (Plan) has been
terminated pursuant to regulations issued by the U.S. Department of
Labor. The Plan was terminated because it was abandoned by \[*name of
the plan sponsor*\].

We have determined that you have an interest in the Plan, either as a
plan participant or beneficiary. Your account balance on \[*date*\]
is/was \[*account balance*\]. We will be distributing this money as
permitted under the terms of the Plan and federal regulations. The
actual amount of your distribution may be more or less than the amount
stated in this letter depending on investment gains or losses and the
administrative cost of terminating the Plan and distributing your
benefits.

Your distribution options under the Plan are {*add a description of the
Plan's distribution options*}. It is very important that you elect one
of these forms of distribution and inform us of your election. The
process for informing us of this election is {*enter a description of
the election process established by the qualified termination
administrator*}.

{*Select the next paragraph from options 1 through 3, as appropriate*.}

{*Option 1: If this notice is for a participant or beneficiary, complete
and include the following paragraph provided the account balance does
not meet the conditions of §2550.404a-3(d)(1)(iii).*}

If you do not make an election within 30 days from your receipt of this
notice, your account balance will be transferred directly to an
individual retirement plan (inherited individual retirement plan in the
case of a nonspouse beneficiary) maintained by {*insert the name,
address, and phone number of the provider if known, other wise insert
the following language* \[a bank or insurance company or other similar
financial institution\]}. Pursuant to federal law, your money in the
individual retirement plan would then be invested in an investment
product designed to preserve principal and provide a reasonable rate of
return and liquidity. {*If fee information is known, include the
following sentence*: Should your money be transferred into an individual
retirement plan, \[*name of the financial institution*\] charges the
following fees for its services: {*add a statement of fees, if any, that
will be paid from the participant or beneficiary's individual retirement
plan*}.}

{*Option 2: If this notice is for a participant or beneficiary whose
account balance meets the conditions of §2550.404a-3(d)(1)(iii),
complete and include the following paragraph*.}

If you do not make an election within 30 days from your receipt of this
notice, and your account balance is \$1,000 or less, federal law permits
us to transfer your balance to an interest-bearing federally insured
bank account, to the unclaimed property fund of the State of your last
known address, or to an individual retirement plan (inherited individual
retirement plan in the case of a nonspouse beneficiary). Pursuant to
federal law, your money, if transferred to an individual retirement plan
would then be invested in an investment product designed to preserve
principal and provide a reasonable rate of return and liquidity. {*If
known, include the name, address, and telephone number of the financial
institution or State fund into which the individual's account balance
will be transferred or deposited. If the individual's account balance is
to be transferred to a financial institution and fee information is
known, include the following sentence*: Should your money be transferred
into a plan or account, \[*name of the financial institution*\] charges
the following fees for its services: {*add a statement of fees, if any,
that will be paid from the individual's account*}.}

{*Option 3: If this notice is for a participant or participant's spouse
whose distribution is subject to the survivor annuity requirements in
sections 401(a)(11) and 417 of the Internal Revenue Code (or section 205
of ERISA), complete and include the following paragraph*.}

If you do not make an election within 30 days from your receipt of this
notice, your account balance will be distributed in the form of a
qualified joint and survivor annuity or qualified preretirement annuity
as required by the Internal Revenue Code. {*If the name of the annuity
provider is known, include the following sentence*: The name of the
annuity provider is \[*name, address and phone number of the
provider*\].}

For more information about the termination, your account balance, or
distribution options, please contact \[*name, address, and telephone
number of the qualified termination administrator and, if different, the
name, address, and telephone number of the appropriate contact
person*\].

Sincerely,

\[*Name of qualified termination administrator or appropriate
designee*\]