Form 457 - Deferred Compensation Plan Employee Enrollment Form (Page 3 of 3) in pdf

457 defeRRed CoMpensAtIon pLAn eMpLoYee enRoLLMent foRM InstRUCtIons

please review the information you have received from ICMA-RC carefully prior to enrolling in

5. allocatioN oF coNtriButioNs – Your contributions can be invested in one or more

the plan. The information is intended to assist you with understanding how the plan works, and

funds available to your plan (your employer may place restrictions on investment in certain

how it can help you save for a secure retirement.

funds). Use whole percentages for your allocations (e.g., 50%, not 33

%). Do not use fixed

dollar amounts. please read Making Sound Investment Decisions: A Retirement Investment

Guide and the appropriate prospectus for full descriptions of the funds. if no allocation

please carefully complete all sections of the form and submit the completed form to your

employer.

instructions are provided, the percentages do not total 100%, or the allocation

instructions are invalid, assets will be allocated to the default investment

1. PersoNal iNForMatioN – Provide all of the requested information. The employer

selected by your employer until additional instructions are received from you.

plan number can be obtained by contacting your employer or ICMA-RC at 800-669-7400.

Review the Notice Regarding Default Investments included in the 457 Enrollment Kit for more

information.

2. coNtriButioN aMouNt – Use this section to specify the percentage and/or dollar

amounts you will contribute to the plan. You can change your contribution amount at any

Please Note: the allocation instructions you provide will affect payroll contributions

time. Your initial contribution election, and any future changes, will be effective as of the first

only. to specify the allocation for any rollover contributions from another eligible

pay period of the calendar month following the date you submit your completed form to your

retirement plan, please contact ICMA-RC for the appropriate transfer form that will provide

employer. For information on the maximum contribution amounts, please go to

instructions on establishing a rollover allocation. In the absence of rollover allocation

org.

instructions, incoming rollover assets will be invested in your payroll contribution

allocation, or in the default investment selected by your employer if your contribution

Roth Contributions – If offered by your plan, you can designate a portion (or all) of your

allocation is not established.

contributions as Roth, which are made on an after-tax basis. These contributions, and associated

earnings, can later be withdrawn tax-free if the requirements for a qualified distribution are

participants residing in new York state will have their investment allocated according to

met. To learn more, visit org/rothanalyzer.

their payroll contribution allocation, per New York State plan rules.

3. BeNeFiciary DesigNatioN – In the event of your death, your designated

6. sigNatures – please be sure to sign and date this section of the form. Return the

beneficiary(ies) will be entitled to any assets remaining in your account. If no beneficiary

completed form to your employer.

information is provided, your estate will be your beneficiary.

please do not delay in submitting the completed enrollment form to your employer. If ICMA-RC

Please provide all of the requested information for each designated beneficiary, including the

receives a contribution to your account prior to your account being established, the contribution

date of birth and Social Security number, as this information will help ICMA-RC locate your

will be returned to your employer.

beneficiaries.

WELCOME TO ICMA-RC!

to designate additional beneficiaries, (1) write “see attached sheet” on the primary

and/or contingent beneficiary line(s) under “Name” and (2) attach and sign a separate piece

ICMA-RC will send you confirmation of your enrollment. Please review the confirmation notice

of paper with your name, plan number, Social Security number, and additional beneficiary

and quarterly statements for your account to ensure your account information is accurate, and

information.

promptly notify ICMA-RC of any updates that are needed.

Beneficiary designations are invalid if percentages are missing, do not equal 100%, or are

expressed with fractions (e.g., 33

%).

4. coMMuNity ProPerty state sPousal coNseNt – If you are married and

live in a community property state (aZ, ca, iD, la, NV, NM, tX, Wa, or Wi), your

spouse is generally entitled to be the primary beneficiary for 100% of your account balance

unless he/she waives that right. If you choose to name someone other than your spouse as

primary beneficiary for your account, your spouse will need to complete this section. Failure

to meet state law requirements with respect to your beneficiary designation may result in your

beneficiary designation being invalid, and the payment of benefits to someone other than your

intended beneficiary(ies).

FRM570-004- 1211-5369-01

Form 457 - Deferred Compensation Plan Employee Enrollment Form Page 3

Related Articles

Related forms

Related Categories