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Vanguard Retirement Plan Enrollment And Change Form

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Vanguard Retirement Plan

Enrollment and Change Form

for Section 403(b)7 Custodial Accounts

Johns Hopkins University

Plan # 090078

Faculty & Sr. Staff

Staff Vol.

Income Deferral Pl. (Residents, Interns, Postdocs)

Select Plan(s):

1. Account Information

Check

New Enrollment

Change

one:

First Name

Middle Initial

Last Name

Date of Birth

(mm/dd/yyyy)

Date of Hire

(mm/dd/yyyy)

Social Security Number

Plan Entry Date

(mm/dd/yyyy)

Street Address

Mailing Address

(no P.O. box)

Must provide a complete

street address. No P.O. Box

City

State

Zip Code

address will be accepted.

Evening Phone Number

Day Time Phone Number

2. Investment of Contributions

Future contributions to the Vanguard Section 403(b)7 Custodial Account on behalf of the Employee shall be invested in the Vanguard Funds as follows:

Allocation

Fund Name

100

Your allocations must equal 100%

1 of 4

T4976_062009

(06/26/2009)

Connect with Vanguard

800-523-1188

*XXXXXXXXXXXXXX090078800*

Vanguard Retirement Plan Enrollment And Change Form

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