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Qualcomm Retirement Planning Review Questionnaire

    Personal Information


    (*) denotes a required field













    SpousalNon-Spousal


    Retirement Information


    Amount of Distribution:
    *Input all applicable fields you are eligible for (Parts A-D)


    1) Part A:




    2) Part B:



    / Part C:



    2) Part D:






    Employee Information





    Outside Capital and Income












    Other Income (please specify $/yr where applicable)













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