Bank Draft Form Page 2

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Select the date(s) of your contributions.
If none selected, then your bank withdrawals will occur on the fifth of each month or quarter selected above.
th
5th
20
Other _________
Select how you would like your contribution allocated, and the total amount.
This amount will be automatically withdrawn from your bank account on the frequency you indicated on the previous page.
Is this a new
Investment Options
Contribution Amount(s)
(Option Number)
Investment Option?
Managed Allocation Option (Age-based)
Yes OR
No
$
,
.
Diversified Equity Option (1968)
Yes OR
No
$
,
.
Fixed Income Option (2823)
Yes OR
No
$
,
.
Guaranteed Option (1967)
Yes OR
No
$
,
.
Aggressive Allocation Option (2283)
Yes OR
No
$
,
.
Moderate Allocation Option (2284)
Yes OR
No
$
,
.
Conservative Allocation Option (2285)
Yes OR
No
$
,
.
Total Contribution Amount
$
,
.
4
Banking Information
You must provide the following information if you choose to contribute through the Automatic Contribution Plan (ACP) or the Electronic Purchase
Option. Separate withdrawals from your bank account will be made for each Investment Portfolio you have selected above. To verify your bank
account, you may submit a voided check or pre-printed deposit slip along with this form; otherwise the information provided below will be added to
your account. Complete this section only if you are establishing ACP or Electronic Purchase Option for your account OR if you want to change
your bank account information. A pre-notification will be sent to your bank and it may take up to ten days to initiate these options.
Checking
Type of Account
(check one):
Savings
Account Number:
Routing Number:
Name(s) on Account
(The Account Owner, Custodian or Entity name must appear on the bank account.)
Bank Name:
Telephone Number:

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