TAX DEFERRED SERVICES, INC

							                                     TAX DEFERRED SERVICES, INC.
                         457 DEFERRED COMPENSATION PLAN ENROLLMENT FORM

                                        San Jose Unified School District

_____ Initial Enrollment        _____ Dollar Change   _____Beneficiary Change    _____ Investment Change

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Name of Participant ______________________________________ Soc. Sec. ________________________

Address ________________________________________________ Birthdate _______________________

City ________________________ State ____ ZIP _________ Hm. Phone ___________________________

Gross Mo. Salary _____________ Wk. Site ______________ Wk. Phone ___________________________

Effective with pay period beginning: Mo. _____ Year _____           10 Pay _____ 12 Pay _____ Other _____

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INVESTMENT OPTIONS

Tax Deferred Services – 457                           $ __________________ per month
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Primary Beneficiary:

NAME __________________________________ RELATIONSHIP ____________________ % ________

NAME __________________________________ RELATIONSHIP ____________________ % ________

Contingent Beneficiary:

NAME __________________________________ RELATIONSHIP ____________________ % ________

NAME __________________________________ RELATIONSHIP ____________________ % ________

I hereby agree to the terms of the Plan Agreement.

I hereby authorize my employer to deduct from my salary the amount specified above and to transmit the
deduction to the above designated company or companies. This authorization will continue in effect until I
submit a timely termination.

The employer and employee are the sole participants in the Plan.

_____________________________________________________________ Date _____________________
Employee’s Signature


_____________________________________________________________ Date _____________________
District Authorized Signature


________Jared Sowards_________________________________________ Phone___(408) 978-1000_____
Agent’s Name