Form 10451 - Annuity 403(B) Salary Reduction Agreement - Linkoln Financial Group
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1
2Annuity
403(b) Salary Reduction Agreement
The Lincoln National Life Insurance Company
PO Box 2340
Fort Wayne IN 46801-2340
Phone 800
4LINCOLN (800 454-6265)
-
Employee’s name
Employee and
Employer
Social Security no.
Gross annual salary $
Information
Employer’s name
Date salary reductions are to begin
■ ■
■ ■
Type of agreement
New agreement
Increase in salary reduction
■ ■
■ ■
Change in funding vehicle
Decrease in salary reduction
■ ■
■ ■
403(b) Pre Tax
403(b) Roth
Agreement
The employee and employer listed above, have entered into this salary reduction agreement to
obtain for the employee the benefits of section 403(b) of the Internal Revenue Code of 1986. In
consideration of the mutual promises and conditions appearing below, it is agreed that:
•
Effective on the date listed above (which is after the effective date of this agreement) the
employer will reduce the employee’s compensation by either $ ____________________ or
__________ % each regular pay date, based on the gross annual salary listed above.
•
Payments shall be applied according to the following schedule:
$______________ per__________ from ___________________ to ___________________.
(month/day/year)
(month/day/year)
$______________ per__________ from ___________________ to ___________________.
)
(month/day/year)
(month/day/year
$______________ per__________ from ___________________ contracted by the parties
(month/day/year)
to this agreement.
•
The employer will apply the amount of the salary reduction under this agreement in
accordance with the section 403(b) program maintained by the employer as contributions to
the nonforfeitable section 403(b) annuity contract(s) (or section 403(b)(7) custodial accounts,
if applicable.). The salary reduction amount shall be allocated among section 403(b) funding
vehicles as follows:
______________________________________
$ ______________ or____________%
______________________________________
$ ______________ or____________%
• $ ________________ or
__________% of any bonus which is not already earned or
currently being earned, should be directed to the funding vehicle(s) noted above.
Signatures
By signing below, you signify that you have read, understand, and agree to the “Agreement” and
“Terms and Conditions” sections of this salary reduction agreement.
Employee’s signature
Date
Employer’s signature
Date
Copy 1 - Employer
Copy 2 - Employee
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates
continued on back
Form 10451 10/05
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