Election To Divest Publicly Traded Employer Stock
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2ELECTION TO DIVEST PUBLICLY TRADED EMPLOYER STOCK
Plan Name: ______________________________________________________________________
Participant Name: _________________________________________________________________
Print or Type Complete Legal Name – First, MI, Last
Social Security Number: ___________________________________________________________
Street Address: ___________________________________________________________________
City: _____________________________
State: ______________
ZIP: ____________
Pursuant to the provisions of the Notice of Right to Divest Publicly Traded Employer Securities
(“Divestment Notice”) which the Plan Administrator previously provided to me, I hereby make the following
elections (“Divestment Election”) to diversify out of some or all of the Employer securities in my Plan’s
account(s).
I have read and understand the Divestment Notice and am only making elections that I am permitted to
make under the Divestment Notice. I understand that the Plan Administrator and Plan Trustee will not act
on this Divestment Election or any portion thereof if my Election is incomplete or improperly completed or
if my Election is not consistent with my rights under the Divestment Notice. I further understand that as to
any Employer securities to which this Election applies, the Trustee will sell such securities at the market
price as established by the applicable securities market as soon as is administratively practicable. The
Trustee then will invest the net cash proceeds resulting from the sale in the alternative investments which
I have elected below.
SECTION 1: SALARY DEFERRAL ACCOUNT
In my Plan’s salary deferral account, I elect to divest:
All. All Employer securities.
Other. The following percentage of my Employer securities:
%.
SECTION 2: EMPLOYER CONTRIBUTION ACCOUNTS
In the following account(s), I elect to divest:
All. All Employer securities in my Plan’s nonelective and matching accounts that I am entitled to
divest.
All nonelective. All Employer securities in my Plan’s nonelective account that I am entitled to
divest.
All matching. All Employer securities in my Plan’s matching account that I am entitled to
divest.
Other: ______________________________________________________________________.
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