"SAINT LOUIS UNIVERSITY"
SAINT LOUIS UNIVERSITY 403(b) ANNUITY PLAN EARNINGS REDUCTION AGREEMENT/ACCOUNT ALLOCATION FORM CY 2012 This Agreement is entered into and signed this _____ day of ______________, 20___, by and between Saint Louis University, hereinafter called "University", and _______________________________, Banner ID Number ____________________, hereinafter called "Employee". The parties to this Agreement hereby agree as follows: Effective with respect to amounts payable during the next available payroll-processing period as of the date of this Agreement or after __________, 20___, the University shall reduce the Employee's gross earnings by the amount specified below. The amount shall be divided between the custodial accounts and/or annuities authorized by the University as designated by the Employee on the applicable investment allocation form provided for that purpose. The Employee understands that he/she must complete the applicable investment allocation forms in order for this Agreement to become effective. The amount of earnings reduction shall be a percentage of earnings in the amount of _____%, not to exceed the maximum allowance under Section 403(b) and/or Section 415 of Internal Revenue Code. If age 50 or over, please check one of the following: ____ I would like to take advantage of the additional catch-up contribution permitted under IRC 414 (c). The applicable amount is included in the above percentage. ____ I do NOT wish to take advantage of additional catch-up contributions permitted under IRC 414 (c). I wish to allocate my total contribution in percentage amounts of earnings in the following manner (subject to any minimum contribution requirements imposed by the mutual fund or insurance company): % OF SALARY TIAA/CREF Retirement Choice Plus Annuities (RCP) __________ Fidelity Investments __________ TIAA/CREF Retirement Annuity* __________ *(no new participants; existing contracts only) Total Basic and Supplemental Contributions __________ After an employee selects his or her preferred funding organization(s), further allocation direction must be given to that organization(s) selecting between various mutual funds or annuities available from that source(s) on the forms they provide. Changes in allocation between the mutual funds or annuities of a particular organization may be arranged directly with that organization. Changes in total allocation between funding organizations require the use of this form. All completed vendor enrollment forms are to be returned to the Benefits Office. This Agreement is legally binding and irrevocable with respect to amounts earned while the agreement is in effect. This agreement may be terminated at any time with respect to amounts not yet earned by giving at least thirty (30) days notice in writing to the other party. __________________________________ __________________________________ Employee Signature Date __________________ MAY BE FAXED TO 314-977-1785 Date of Birth