(b)(1) Provide the name and address of the entity for which the petition is filed;
(b)(2) Provide the names and addresses of the plan administrator and plan sponsor(s) of the plan or other arrangement for which the finding is sought;
(b)(3) Identify the state or states whose law or jurisdiction the petitioner claims has been asserted over the petitioner, and provide the addresses and names of responsible officials;
(b)(4) Include affidavits or other written evidence showing that:
(b)(4)(i) State jurisdiction has been asserted over or legal process commenced against the petitioner pursuant to state law;
(b)(4)(ii) The petitioner is an employee welfare benefit plan as defined at section 3(1) of ERISA (
29 U.S.C. 1002(1)
) and 29 CFR
2510.3–1
and is covered by title I of ERISA (
see
29 U.S.C. 1003
);
(b)(4)(iii) The petitioner is established or maintained for the purpose of offering or providing benefits described in section 3(1) of ERISA (
29 U.S.C. 1002(1)
) to employees of two or more employers (including one or more self-employed individuals) or their beneficiaries;
(b)(4)(iv) The petitioner satisfies the criteria in 29 CFR
2510.3–40(b)
; and
(b)(4)(v) Service has been made as provided in
§2570.155
.
(b)(5) The affidavits shall set forth such facts as would be admissible in evidence in a proceeding under 29 CFR part
18
and shall show affirmatively that the affiant is competent to testify to the matters stated therein. The affidavit or other written evidence must set forth specific facts showing the factors required under paragraph (b)(4) of this section.
