Fremont 457 Enrollment Form
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2FREMONT 457 ENROLLMENT FORM
PERSONAL INFORMATION
(please print clearly)
_ _ _
_ _
_ _ _ _
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NAME: __________________________________________________________ SOCIAL SECURITY NUMBER:
4 0 1 7 6 0
DATE OF BIRTH: ____________________________________________________ SCHOOL DISTRICT PLAN NUMBER:
ADDRESS:
____________________________________________________________ APT:____________________________________
CITY: ____________________________________________________________ STATE:_________ ZIP CODE: ____________________
PHONE:______________________ E-MAIL: ____________________________________________ HIRE DATE: ____________________
OPTIONAL
INVESTMENT ALLOCATION OF CONTRIBUTIONS
Please refer to the Plan Highlights and Fund Fact Sheets located at
for additional information about the CalSTRS
Pension2 Program, the Easy Choice Portfolios, Voya Fixed Plus III and the mutual fund investment options. The Investment Allocation
of Contributions elected below will apply to all contribution sources. Eligibility to receive Employer Contributions under the plan is
determined by the Employer. Completion of this Enrollment Form does not establish your eligibility to receive Employer Contributions.
If you do not designate fund elections or elections do not total 100%, your investment allocation will default 100% to the Voya Fixed
Plus III
. Please check only
ONE
of the two options below in this section:
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ELECTION A - EASY CHOICE PORTFOLIO
❏
By selecting an Easy Choice Portfolio you are designating 100% of your contributions to that particular portfolio. You also agree to have
your elections rebalanced periodically in order to stay within the investment percentages of the portfolio you have chosen. (The CalSTRS
Pension2 Easy Choice Portfolios are created by CalSTRS from the list of investment options below, in conjunction with its Financial Planning Consultant.)
If you would like to keep things simple, answer two questions.
1. When will you retire: (Check the box that best defines your expected retirement year)
2050+
2040
2030
2020
RETIRED
❏
❏
❏
❏
❏
2. What type of investor are you: (Check the appropriate box)
CONSERVATIVE
MODERATE
AGGRESSIVE
❏
❏
❏
OR
ELECTION B - BUILD YOUR OWN PORTFOLIO
❏
If you prefer to choose among investments in different asset classes and develop your own portfolio to match your time horizon and
tolerance for assuming risk, consider a “build your own portfolio” strategy. Allocations must equal 100%. If your selection is invalid or
unclear, your contributions will be automatically invested for you in the Voya Fixed Plus III
.
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VOYA FIXED PLUS III
VANGUARD MID CAP INDEX
_________ .00%
________ .00%
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FEDERATED US TREASURY CASH
ESG MANAGERS GROWTH INST
_________ .00%
________ .00%
VANGUARD TOTAL BOND MARKET
GMO GLOBAL EQUITY ASSET
_________ .00%
________ .00%
VANGUARD SHORT-TERM BOND INDEX
VANGUARD EMERGING MARKETS
_________ .00%
________ .00%
VANGUARD INFLATION PROTECTED
VANGUARD DEVELOPED MARKETS
_________ .00%
________ .00%
VANGUARD TOTAL STOCK MARKET
DODGE AND COX INTERNATIONAL
_________ .00%
________ .00%
VANGUARD INSTITUTIONAL INDEX
DFA INTERNATIONAL SMALL CO
_________ .00%
________ .00%
TIAA-CREF SOCIAL CHOICE EQUITY
ARTISAN INTERNATIONAL
_________ .00%
________ .00%
DODGE AND COX STOCK
VANGUARD REIT INDEX
_________ .00%
________ .00%
AMERICAN GROWTH FUND
PIMCO ALL ASSET
_________ .00%
________ .00%
VANGUARD SMALL CAP INDEX
Total Percent of Investment Allocation Must Equal
100%
_________ .00%
Voya Fixed Plus III is offered through a group annuity contract by Voya Retirement Insurance and Annuity Company, P.O. Box 990063, Hartford, CT 06199-0063
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