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Legal Name Change Washington State - Excel

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Legal Name Change Washington State - Excel Powered By Docstoc
					                                       Asset Allocation to American Funds PlanPremier
Please read the instructions in the associated PDF prior to filling this form out.This will give more information about your options and the
recommendations that FMN is making for your retirement savings.


Section 1: Owner Information (all information is required)
USE YOUR LEGAL NAME as you wish it to appear on your accounts.

Owner:                                                         SSN:                                                   DOB:
Mailing Address as it should appear on your American Funds account until otherwise notified:

Street:                                                        City:                                                  State:                             Zip:
Physical Address if different than mailing address:

Street:                                                        City:                                                  State:                             Zip:


Email:

US Drivers
License or                                                                                                            Expiration
Passport #                                                     State:                                                 Date:


Section 2: Allocation
I would like to allocate all new payroll deductions according to the following (this will not re-allocate existing funds):
Allocation recommendations are available in the instructions, or at www.piplan.org. Fund descriptions are also available at www.americanfunds.com
Additional Funds are available and can be allocated through the Plan Premier website after your account is established. Contact FMN for a list of available funds.

Part 1                   Recommended Allocation Flowchart

American Mutual Fund

Growth Fund of America

Income Fund of America

New Perspective Fund

Washington Mutual Investors Fund

SmallCap World Fund

Bond Fund of America

Cash Management Trust (MMKT)
                                                      Total must equal 100%


Part 2
My monthly contribution is:
This represents a change from my current contribution (Y/N)


How would you like this distributed?

Roth 403(b) (recommended)

Traditional 403(b)

*Maximum annual contribution to all 403(b) funds is $15,500,
or $20,500 for persons over age 50
Section 3: Beneficiary Designation

If more than two primary or four contingent beneficiaries, please indicate in your email or an additional letter.

Primary Beneficiaries - Required

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:

Contingent Beneficiaries - Optional

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:

Name:                                               SSN:                                            Relationship:               DOB:          %

Street:                                             City:                                           State:                      Zip:



Today's Date:                                                     Signature (or type your name):

Please save and upload this form to https://www.piplan.org/upload.asp or print and mail to:                         FMN
                                                                                                                    Attn: PI Department
                                                                                                                    26041 Acero
                                                                                                                    Mission Viejo, CA 92691

				
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Description: Legal Name Change Washington State document sample