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<HTML <HEAD> <TITLE>Corporate Benefits Request for Change </TITLE> </HEAD> <TABLE border> <TR><TD><IMG align=bottom SRC="ben-pics/lmclogo.gif"></TD> <TD valign=middle><font size=+2><B>Benefits Request for Change (RFC)</B></font> </TD></TR> </TABLE> <FORM METHOD="POST" ACTION="http://depot.vf.mmc.com/cgiaccept/corpben/mailform.pl"> <TABLE><TR><TD> <H4>System: </H4></TD> <TD><INPUT TYPE="text" NAME="sysname" SIZE="32" MAXLENGTH="32"></TD> <TD><H4>Date: </H4></TD> <TD><INPUT TYPE="text" NAME="date" SIZE="8" MAXLENGTH="8"></TD></TR> </TABLE> <TABLE><TR><TD><H4>Title: </H4></TD> <TD><INPUT TYPE="text" NAME="title" SIZE="40" MAXLENGTH="60"></TD> <TD><IMG SRC="ben-pics/WORLD.GIF"></TD></TR> </TABLE> <HR> <H3> </H3> <CENTER> <TABLE BORDER=1> <TR> <TH>Originator Name</TH> <TD><INPUT TYPE="text" NAME="name" SIZE="40" MAXLENGTH="80"></TD> </TR> <TR> <TH>E-Mail Address</TH> <TD><INPUT TYPE="text" NAME="email" SIZE="40" MAXLENGTH="80"></TD> </TR> <TR> <TH>Organization</TH> <TD><INPUT TYPE="text" NAME="organization" SIZE="40" MAXLENGTH="80"></TD> </TR> <TR> <TH>Phone Number</TH> <TD><INPUT TYPE="text" NAME="phone" SIZE="20" MAXLENGTH="20"></TD> </TR> <TR> <TH>RFC Category:</TH> <TD><SELECT NAME="category"> <OPTION SELECTED>H/W (Hardware) <OPTION>S/W (Software) <OPTION>Documentation <OPTION>Facility </SELECT> </TD> </TR> </TABLE> </CENTER> <P><B>Description of Change:</B> <BLOCKQUOTE> <TEXTAREA NAME="COMMENTS" ROWS="5" COLS="60"></TEXTAREA> </BLOCKQUOTE> <CENTER><P><INPUT TYPE="submit" VALUE="Send your feedback"> <INPUT TYPE="reset"></P></CENTER> </FORM> <CENTER> <P><IMG SRC="ben-pics/YIN_YANG.GIF"><P> </CENTER> </BODY> </HTML>