Form Hr 17 - Tda Salary Reduction Agreement/change Of Vendor Form Page 2
Download a blank fillable Form Hr 17 - Tda Salary Reduction Agreement/change Of Vendor Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Hr 17 - Tda Salary Reduction Agreement/change Of Vendor Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3C. CHANGE VENDOR ONLY
I elect to change my Tax-Deferred Account vendor
Regular TDA (your contributions are not taxed, but your earnings are)
Regular TDA (your contributions are not taxed, but your earnings are)
Regular TDA (your contributions are not taxed, but your earnings are)
Regular TDA (your contributions are not taxed, but your earnings are)
Regular TDA (your contributions are not taxed, but your earnings are)
Vendor #1: from _____________________________________________ to __________________________________________
Name of current vendor
Name of new vendor
Vendor #2: from _____________________________________________ to __________________________________________
Name of current vendor
Name of new vendor
Roth TDA (your contributions are taxed, but your earnings are not)
Roth TDA (your contributions are taxed, but your earnings are not)
Roth TDA (your contributions are taxed, but your earnings are not)
Roth TDA (your contributions are taxed, but your earnings are not)
Roth TDA (your contributions are taxed, but your earnings are not)
Vendor #1: from _____________________________________________ to __________________________________________
Name of current vendor
Name of new vendor
Vendor #2: from _____________________________________________ to __________________________________________
Name of current vendor
Name of new vendor
I understand the dollar amount or percentage amount of my contribution will not change.
D. EMPLOYEE AGREEMENT
I understand that I bear the risk of the performance of the product(s) of my choosing, that The Texas A&M University System has no
fiduciary responsibilities in this area, and that The Texas A&M University System is not liable for any tax consequences occurring under
this program. I acknowledge that current federal tax code requires that I begin receiving a minimum distribution from the accumulated
funds by April 1 following the year in which I reach age 70½ or retire, whichever is later. This agreement shall be legally binding and
irrevocable with respect to salary earned while this agreement is in effect. I understand that either party may change or terminate this
agreement as of the end of any month, so that it will not apply to compensation not yet received, by giving written notice of the date of
the change or termination. I understand and agree to the following conditions:
1.
My election will be subject to retroactive opinions and rulings issued and to be issued by the Internal Revenue Service affecting Sec-
tion 403(b), Section 415 and 402(g) of the Internal Revenue Code.
2.
Any change in interpretation of Sections 403(b), 415 or 402(g) of the Internal Revenue Code or Regulations may require recalcula-
tion of my maximum contribution limit and a change in the amount and/or tax status of accounts purchased under provisions of
that Code.
3.
In the event of any adverse ruling by the Internal Revenue Service regarding the calculation of my maximum contribution limit or
my purchase of Tax-Deferred Accounts, I agree to be responsible to the Internal Revenue Service and acknowledge that The Texas
A&M University System has the right to make such adjustments in the amount of my maximum contribution limit as deemed neces-
sary by the System for compliance with such rulings.
__________________________________________________________________
__________________________________
Employee signature
Date
E. VENDOR INFORMATION (required only if using individual vendor representative)
_____________________________________________
______________________________________________________
Name of Representative
Company
_______________________________
_______________________________
_______________________________
Telephone number
Fax number
Email address
F. TO BE COMPLETED BY YOUR HUMAN RESOURCES OR PAYROLL OFFICE
Processed by ____________________________________________________
Date ____________________________
2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business