Orm Enrollment - Plan Pension O
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1OFFSHORE PENSION PLAN - ENROLLMENT FORM
Employment Number:
ID:
MEMBER INFORMATION
First Name
Middle Name
Family Name
/
/
Birth Date:
Citizenship:
Day
Month
Year
Sex:
Male
Female
Marital Status:
Single
Married
Home Address:
City:
State:
Postal code:
BENEFICIARY
(The person(s) to whom proceeds are payable on the death of the Participant under the terms of the Plan. This designation is revocable, unless specified otherwise.)
Last Name
First Name
Initial
Relationship
Share
Primary
Primary
Total Primary Beneficiary/ies percentages must total 100%
Total 100%
Contingent
Contingent
Total Contingent Beneficiary/ies percentages must total 100%
Total 100%
Attach a separate sheet if necessary.
FUND ALLOCATION INSTRUCTIONS
please pick from the funds listed OR one of the portfolios.
You CANNOT select from both the list of funds and the portfolios; you must select either from the funds or ONE portfolio.
US Funds
Fund Code
Percentage
Model Portfolios
Check one
Vanguard Prime Liquidity Fund
101
Very Conservative Portfolio
Vanguard US Government Bond Index Fund
102
Conservative Portfolio
Vanguard US 500 Stock Index Fund
103
Moderate Portfolio
Vanguard US Opportunities Fund
104
Moderately Aggressive Portfolio
Vanguard US Discoveries Fund
105
Aggressive Portfolio
Vanguard European Stock Index Fund
106
Vanguard Euro Government Bond Index Fund
107
Vanguard Japan Stock Index Fund
108
Vanguard Global Stock Index Fund
109
Vanguard US Fundamental Value Fund
110
Total
100%
I hereby request that I be included in the Lebanese American University Savings Plan (the “Plan”) as presented to me. I agree to comply with the
requirements of the Plan. I authorize Lebanese American University to deduct contributions in the amount of ______% from my earnings for this Plan.
EMPLOYEE SIgNATURE:
DATE:
/
/
Day
Month
Year
OFFICE USE ONLY
Employment Date:
Plan Entry Date:
/
/
/
/
Day
Month
Year
Day
Month
Year
LAU AUTHORIzED SIgNATURE:
DATE:
/
/
Day
Month
Year
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