EMPLOYER INFORMATION NOTE Clause Samples
EMPLOYER INFORMATION NOTE. If multiple Employers are adopting the Plan, complete this section based on the lead Employer. Additional Employers may adopt this Plan by attaching executed signature pages to the back of the Employer's Adoption Agreement.
(a) NAME AND ADDRESS: PICOM Insurance Company 4295 ▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇
(b) TELEPHONE NUMBER: 517-349-6500
(c) EMPLOYER TAX ID NUMBER: 38-2▇▇▇▇▇▇ TRUST TAX ID NUMBER: 38-2▇▇▇▇▇▇
(d) FORM OF BUSINESS: [ ] (i) Sole Proprietor [ ] (ii) Partnership [X] (iii) Corporation [ ] (iv) "S" Corporation (formerly known as Subchapter S) [ ] (v) Other: __________________________________________
(e) NAME(S) OF INDIVIDUAL(S) AUTHORIZED TO ISSUE INSTRUCTIONS TO THE TRUSTEE/CUSTODIAN: Vict▇▇ ▇. ▇▇▇▇▇ ▇▇▇ Ann ▇. ▇▇▇▇▇, R.N., J.D.
(f) NAME OF PLAN: PICOM Insurance Company Pension Plan
(g) THREE DIGIT PLAN NUMBER FOR ANNUAL RETURN/REPORT: 004
EMPLOYER INFORMATION NOTE. If multiple Employers are adopting the Plan, complete this section based on the lead Employer. Additional Employers may adopt this Plan by attaching executed signature pages to the back of the Employer's Adoption Agreement.
(a) NAME AND ADDRESS: East-West Bank ▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ (b) TELEPHONE NUMBER: (▇▇▇) ▇▇▇-▇▇▇▇ (c) TAX ID NUMBER: ▇▇-▇▇▇▇▇▇▇ (d) FORM OF BUSINESS: o (i) Sole Proprietor o (ii) Partnership ý (iii) Corporation o (iv) "S" Corporation (formerly known as Subchapter S) o (v) Other: (e) NAME OF PLAN: East-West Bank Employees 401(k) Savings Plan (f) THREE DIGIT PLAN NUMBER FOR ANNUAL RETURN/REPORT: 001