Church of the Lutheran Brethren Pension & Benefit Office

Employee Pension & Benefit Worksheet

Church/Employer Information

Benefits Being Provided

Please provide information on all benefits provided to the employee, even if not provided through the CLB synodical offices.

Pension Contribution Information

The following information is needed to determine the correct pension billing for your employee. Please use Annual Figures.

Signature Information

Person completing the form

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PO Box 655
Fergus Falls, MN 56538


Phone: 218-739-3336

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