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401(k): Election Change Request

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This 401(k) Election Change Request can be used by an individual to change the contribution amount to their 401(k) account. This form should be distributed to employees of a small business so they can easily change their contribution amount. The employee can customize their information, the 401(k) plan’s information, the old and new contribution rate, and more. This form is ideal for individuals or small businesses that want to change the contribution amount to their 401(k) account.

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									401(k): Election Change
Request
This 401(k) Election Change Request can be used by an individual to change the
contribution amount to their 401(k) account. This form should be distributed to
employees of a small business so they can easily change their contribution amount. The
employee can customize their information, the 401(k) plan’s information, the old and
new contribution rate, and more. This form is ideal for individuals or small businesses
that want to change the contribution amount to their 401(k) account.
                           401(K) ELECTION CHANGE REQUEST


1.        PARTICIPANT INFORMATION

          a.      Full Legal Name: ____________________ [Instructions: Insert name]

          b.      Date of Birth: __________________ [Instructions: Insert date of birth]

          c.      Social Security Number: ____-___-____ [Instructions: Insert SSN]

          d.      Address: ____________________________ [Instructions: Insert address]

          e.      Email address: ___________@__________ [Instructions: Insert email address]

          f.      Phone: (___)____-______ [Instructions: Insert phone number]

2.        PLAN INFORMATION

          a.      Name of Company: _________________ [Instructions: Insert name]

          b.      Employer Identification Number: ________________ [Instructions: Insert EIN]

          c.      Plan Administrator Name: ________________ [Instructions: Insert name]

          d.      Plan Name: _________________ [Instructions: Insert plan name]

          e.      Plan Number: ________________ [Instructions: Insert plan number]

3.        CHANGE OF CONTRIBUTION RATE

          a.      Prior Contribution: ___% [Instructions: Insert percentage] of Participant’s
salary.

          b.      New Contribution: ___% [Instructions: Insert percentage] of Participant’s
salary.

        c.     Further Change: Participant understand that Participant may change, suspend and
resume contributions at such times as described in the terms of the Plan and that Participant’s
salary reduction participation is completely voluntary.

        d.     Legal Limits: Participant further understands that the aggregate contributions
shall not exceed the limits established by the IRS.

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© Copyright 2014 Docstoc Inc. registered document proprietary, copy not              2
IN WITNESS WHEREOF the parties have duly executed this form as of the date set forth
below.

PARTICIPANT:                                                     COMPANY:



__________________________                                       __________________________
__________ [Instructions: Insert name]                           __________ [Instructions: Insert name]
                                                                 Plan Administrator

Date: _______________________                                    Date: ___________________________




© Copyright 2014 Docstoc Inc. registered document proprietary, copy not                        3

								
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