Form 5305-Simple - Savings Incentive Match Plan For Employees Of Small Employers (Simple) - For Use With A Designated Financial Institution Page 3

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Form 5305-SIMPLE (Rev. 3-2012)

Page

Model Notification to Eligible Employees

I. Opportunity to Participate in the SIMPLE IRA Plan

You are eligible to make salary reduction contributions to the

SIMPLE

IRA plan. This notice and the attached summary description provide you with information that you should consider before you

decide whether to start, continue, or change your salary reduction agreement.

II. Employer Contribution Election

For the

calendar year, the Employer elects to contribute to your SIMPLE IRA (employer must select either (1), (2), or (3)):

(1)

A matching contribution equal to your salary reduction contributions up to a limit of 3% of your compensation for the

year;

(2)

A matching contribution equal to your salary reduction contributions up to a limit of

(employer must insert a

number from 1 to 3 and is subject to certain restrictions) of your compensation for the year; or

A nonelective contribution equal to 2% of your compensation for the year (limited to compensation of $250,000*) if you

(3)

(employer must insert an amount that is $5,000 or less) in

are an employee who makes at least

compensation for the year.

III. Administrative Procedures

To start or change your salary reduction contributions, you must complete the salary reduction agreement and return it to

(employer should designate a place or

individual) by

(employer should insert a date that is not less than 60 days after notice is given).

Model Salary Reduction Agreement

I. Salary Reduction Election

Subject to the requirements of the SIMPLE IRA plan of

(name of

employer) I authorize

(which equals

of my current rate of pay) to be withheld from

my pay for each pay period and contributed to my SIMPLE IRA as a salary reduction contribution.

II. Maximum Salary Reduction

I understand that the total amount of my salary reduction contributions in any calendar year cannot exceed the applicable

amount for that year. See instructions.

III. Date Salary Reduction Begins

I understand that my salary reduction contributions will start as soon as permitted under the SIMPLE IRA plan and as soon as

administratively feasible or, if later,

(Fill in the date you want the salary reduction contributions to

begin. The date must be after you sign this agreement.)

IV. Duration of Election

This salary reduction agreement replaces any earlier agreement and will remain in effect as long as I remain an eligible employee

under the SIMPLE IRA plan or until I provide my Employer with a request to end my salary reduction contributions or provide a

new salary reduction agreement as permitted under this SIMPLE IRA plan.

Signature of employee

Date

This is the amount for 2012. For later years, the limit may be increased for cost-of-living adjustments. The IRS announces the increase, if any, in a news release, in

the Internal Revenue Bulletin, and on the IRS website at IRS.gov.

5305-SIMPLE

Form

(Rev. 3-2012)