Equity Contribution Agreement by tle11209


Equity Contribution Agreement document sample

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									  ELCA Retirement Plan
                                                    t r bu t
                                          Cro nsoredipas tors i o n ag r e e ment
                                          f o spo n

the following agreements are between you and your employer. the elca board of pensions is the administrator of this plan and
should be notified when these agreements change.

 A     Y our p erso nal i nf o rmat io n
                                                                                                                       –          –
     Name (first, middle iNitial, last)                                                                 social security Number

                                                                                                        (          )
     address                                                           e-mail address                   home phoNe

     city                                                              state                            Zip code

 B     E mp loyme nt i nf o rmati o n
                                                                                                    (          )
     Name of spoNsoriNg employer                                                                    employer phoNe

     address                                                city                                    state              Zip code

     i am   (check [4] one)     paid by the hour    salaried       full-time     part-time ______________ hours worked per week

 C     Con trib u ti o ns to o th er r e t ir e me n t pl an s
     i contributed or intend to contribute to a 403(b) plan (other than the elca retirement plan) or 401(k) plan this calendar year.
            No           yes     if yes, indicate the amount $________________ year__________________

 D     Housin g eq ui ty co ntri bu t io n ag r e e me n t
     Complete 1 or 2
        1. i agree to enter into or change a housing equity agreement with my employer effective            (mm/dd/yyyy)     ____________.

                 my employer will send the following housing equity contribution (percentage of defined compensation _____%
                 or dollar amount $_________________________________) monthly to my account in the elca retirement plan.

            2. i elect to terminate my housing equity contribution agreement with my employer effective      (mm/dd/yyyy)      ____________.

                                                                                                                           continued on reverse side

                                                                                                                                      20-279 (9/2009)
  E     Memb er p retax co ntri bu t io n ag r e e me n t
      Complete 1 or 2
      this agreement is between you and your employer; the board of pensions must be notified when the agreement changes.
          1. i agree to enter into a pretax contribution agreement with my employer to start on the following pay date
              ____________________. (please talk to your employer so this date matches the date in section g.)
                 i agree to contribute $___________ or ___________% of my defined compensation to my elca retirement
                 account each pay period.
           2. i elect to terminate my member pretax contribution agreement with my employer effective                                       (mm/dd/yyyy)       __________.
                 the contributions are due at the board of pensions within 15 business days following the month in which these amounts would have otherwise been paid to you.

                 Note: this agreement applies only to amounts earned after the agreement has been signed by you and your employer. as required by treasury regulations
                 §1.402(g)(3)-1, this agreement is legally binding and irrevocable with respect to amounts earned while this agreement is in effect. at any time, by written
                 notification to your employer, you may terminate this agreement with respect to amounts not yet earned.

           the internal revenue service sets annual limits for retirement plan contributions. contact the board of pensions
           service center for more details.

  F     S ign ature o f member
      i agree to participate in the elca retirement plan as indicated on this form. if i need additional information, i know i can
      contact the board of pensions.

      sigNature of member (REquiREd)                                                                                                      date (mm/dd/yyyy)

 G      S i gn a ture o f s po ns o ri ng e m pl o y e r
      We hereby declare this employee works at least 15 hours per week, six or more months a year and is eligible for
      participation in the elca retirement plan. We agree to be bound by the terms and conditions of the plan document
      and to make contributions based on the information on this form.

      Payroll frequency (for billing purposes):
                                                                             date you started spoNsoriNg this employee iN the program (mm/dd/yyyy)
         monthly on ______________ day of month
         semimonthly (check [4] one)
             1st, 16th of month                                              Name of spoNsoriNg employer (REquiREd)
             15th, last day of month
             other (specify) ______________________
         biweekly                                                            sigNature of employer represeNtative (REquiREd)                      elca employer id

      PAy dAtE mEmBER PREtAx ContRiBution StARtS                             title                                                                date (mm/dd/yyyy)

Return this completed form to the Board of Pensions Service Center.
service center
elca board of pensions
800 marquette ave., suite 1050
minneapolis, mN 55402-2892

(800) 352-2876 • (612) 333-7651
fax: (612) 334-5399
mail@elcabop.org • www.elcabop.org

printed with soybean inks on recycled paper containing 20 percent post-consumer waste.                                                                                   20-279 (9/2009)

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