ADOPTION OF AGREEMENT BY EMPLOYER AND CUSTODIAN Sample Clauses

ADOPTION OF AGREEMENT BY EMPLOYER AND CUSTODIAN. By this Employer Adoption Agreement, the Employer, duly qualified as an organization described in section 403(b)(1)(A) of the Code, hereby agrees with the Custodian, duly qualified as a bank described in Section 401(d)(1) of the Code, to open a separate Custodial Investment Account (the "Account"), for the benefit of each Employee of the Employer who signs a Xxxxxxx 403(b) Plan Employee Application which is accepted by the Custodian, pursuant to the Xxxxxxx 403(b) Agreement (the "Agreement") hereby adopted by the Employer and the Custodian, and the Employer and the Custodian further agree to the provisions contained in this Employer Adoption Agreement. STATE STREET BANK AND TRUST COMPANY ------------------------------------- By ------------------------------------- Signature of Employer Custodian Sample Organization ------------------------------------- By ------------------------------------- Employer Date Anytown, USA IMPORTANT: The Xxxxxxx 403(b) Agreement, ------------------------------------- including this Employer Adoption Address of Employer Agreement, becomes effective upon the date this Employer Adoption Agreement is signed by the Employer and the Custodian. -------------------------------------------------------------------------------- Sample Employee Application -------------------------------------------------------------------------------- The employee application appearing below reflects the selections set forth in the sample adoption agreement on pages 10-11. -------------------------------------------------------------------------------- Employee Application Return this form to: Employee Benefits Dept. 1. NAME AND ADDRESS OF EMPLOYEE Name ______________________________________________________________________ Address ___________________________________________________________________ City ___________________ State _______ Zip _______ Date of Birth __________ Social Security Number __________ Employee Identification Number __________ 2. NAME AND ADDRESS OF EMPLOYER Name ______________________________________________________________________ Address ___________________________________________________________________ City ____________________________ State _______________ Zip _______________ Employer Group Number ______________ Tax Identification Number ____________