Fillable Calstrs 403(B) Enrollment Form printable pdf download

403(b) ENROLLMENT FORM

1. PERSONAL INFORMATION

(please print clearly)

_ _ _ - _ _ - _ _ _ _

NAME: __________________________________________________________ SOCIAL SECURITY NUMBER:

_ _ _ _ _ _

SCHOOL DISTRICT NAME: ______________________________________________ SCHOOL DISTRICT PLAN NUMBER:

School district name and plan number list is provided at the back of this form.

DATE OF BIRTH: ____________________________________________________

ADDRESS: ______________________________________________________________ APT: __________________________________

CITY: ____________________________________________________________ STATE:_________ ZIP CODE: ____________________

PHONE: _________________________________________

2. INVESTMENT ALLOCATION OF CONTRIBUTIONS

Please refer to the Plan Highlights and Fund Fact Sheets located at for additional information about the CalSTRS

Pension2 Program, the Easy Choice Portfolios, Voya Fixed Plus III and the mutual fund investment options. The Investment Allocation

of Contributions elected below will apply to all contribution sources. Eligibility to receive Employer Contributions under the plan is

determined by the Employer. Completion of this Enrollment Form does not establish your eligibility to receive Employer Contributions.

If you do not designate fund elections or elections do not total 100%, your investment allocation will default 100% to the Voya Fixed

Plus III

. Please check only ONE of the two options below in this section:

❏

ELECTION A — EASY CHOICE PORTFOLIO

By selecting an Easy Choice Portfolio you are designating 100% of your contributions to that particular portfolio. You also agree to have

your elections rebalanced periodically in order to stay within the investment percentages of the portfolio you have chosen.

(The CalSTRS

Pension2 Easy Choice Portfolios are created by CalSTRS from the list of investment options below, in conjunction with its Financial Planning Consultant.)

If you would like to keep things simple, answer two questions.

1. When will you retire: (Check the box that best defines your expected retirement year)

❏

2050+

2040

2030

2020

RETIRED

2. What type of investor are you: (Check the appropriate box)

❏

CONSERVATIVE

MODERATE

AGGRESSIVE

❏

ELECTION B — BUILD YOUR OWN PORTFOLIO

If you prefer to chooose among investments in different asset classes and develop your own portfolio to match your time horizon and

tolerance for assuming risk, consider a “build your own portfolio” strategy. Allocations must equal 100%. If your selection is invalid or

unclear, your contributions will be automatically invested for you in the Voya Fixed Plus III

VOYA FIXED PLUS III

_________

VANGUARD MID CAP INDEX

________

.00%

FEDERATED US TREASURY CASH

_________

ESG MANAGERS GROWTH INST

________

.00%

VANGUARD TOTAL BOND MARKET

_________

GMO GLOBAL EQUITY ASSET

________

.00%

VANGUARD SHORT-TERM BOND INDEX

_________

VANGUARD EMERGING MARKETS

________

.00%

VANGUARD INFLATION PROTECTED

_________

VANGUARD DEVELOPED MARKETS

________

.00%

VANGUARD TOTAL STOCK MARKET

_________

DODGE AND COX INTERNATIONAL

________

.00%

VANGUARD INSTITUTIONAL INDEX

_________

DFA INTERNATIONAL SMALL CO

________

.00%

TIAA-CREF SOCIAL CHOICE EQUITY

_________

ARTISAN INTERNATIONAL

________

.00%

DODGE AND COX STOCK

_________

VANGUARD REIT INDEX

________

.00%

AMERICAN GROWTH FUND

_________

PIMCO ALL ASSET

________

.00%

100%

VANGUARD SMALL CAP INDEX

_________

Total Percent of Investment Allocation Must Equal

.00%

Voya Fixed Plus III is offered through a group annuity contract by Voya Retirement Insurance and Annuity Company, P.O. Box 990063, Hartford, CT 06199-0063

PAGE 1 of 6

Calstrs 403(B) Enrollment Form

Related Articles

Related forms

Related Categories