FACULTY/STAFF SALARY REDUCTION AGREEMENT FOR 403b SUPPLEMENTAL RETIREMENT ACCOUNT
Name ________________________________ Social Security Number _________________
Under Age 50
Age 50 and Over
I.
When would you like the contribution/change to be effective? Effective the next available pay period OR Effective __________________________ (insert date)
II. How much is the requested salary reduction? Reduce pay by (select only one): Flat dollar amount per pay (NO ANNUAL AMOUNTS PLEASE) If a flat dollar amount is elected, the deduction will be taken every time you receive a paycheck (For faculty this includes summer pay) Percent of all compensated earnings (For faculty this includes summer pay.)
*If you wish to contribute more than the maximum allowed as indicated on the reverse side of this form, you must attach a copy of your Maximum Exclusion Allowance (MEA) Calculation with this form. MEA calculations can be obtained through your investment vendor. Maximum contribution limits are listed on the reverse of this form. Elections will remain effective until a new salary reduction form is submitted to Human Resources. Maximized contributions will not automatically increase each year. Once maximum contribution amounts are met, deductions will cease for the remainder of the calendar year. Beginning January of the following year, deductions will begin again with the same amounts previously elected unless a new salary reduction form has been completed. III. Where would you like the contributions sent? If you select more than one, please indicate amount/percent to be sent to each vendor. TIAA-CREF American Funds Fidelity __________ New England (Existing Members Only)
IV. Please select one: Established 403b Supplemental Retirement Account 403b Supplemental Retirement Account Application(s) attached _____ 403b Supplemental Retirement Account Application Completed with Financial Advisor
Please complete reverse side of this form.
I HEREBY, for myself, my heirs, executors and personal representatives hold harmless and indemnify the University, its officers, faculty and staff members, from every claim and demand for penalties, taxes, withholding and/or interest which may be made by reason of challenge to the tax-qualified status on any annuities or mutual funds purchased by the University for me or by reason of challenge to the maximum exclusion allowance. I have read the terms of this agreement on the reverse side and understand and accept these terms. I authorize the amount stated in Section II to be deducted and transmitted as I have indicated in Section III.
_________________________________________________ Faculty/Staff Member Signature
_____________________ Date
_________________________________________________ Human Resources Representative Signature
_____________________ Date
MAXIMUM CONTRIBUTION LIMITS
Tax Year 2002 2003 2004 2005 2006 2007 Under Age 50 $11,000 $12,000 $13,000 $14,000 $15,000 $15,500 Age 50 and over $12,000 $14,000 $16,000 $18,000 $20,000 $20,500
This agreement is legally binding and irrevocable for both the University and the Participant with respect to the amounts earned while the agreement is in effect. However, either party may terminate the agreement given at least two weeks written notice. The agreement will not apply to salary earned after the agreement is terminated. This agreement replaces any previous agreements. The purpose of the University in executing this amendment is to provide the Participant with an opportunity to benefit from the provisions of section 403b of the Internal Revenue Code of 1954 (as amended) of the United States. The Participant understands that there are choices available and is responsible for requesting, reading and understanding the prospectus prior to the designation of retirement fund options. The University, its officers and faculty and staff are not responsible for any information or advice provided by the respective companies, or any loss as a result of the participant’s selection. The University does not warrant any particular tax consequences to the Participant.
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