Type of deferral. The deferrals selected above will be: Pre-Tax 401(k) deferrals Xxxx 401(k) deferrals (after-tax)
Type of deferral. I elect to make (if in A above you elected a deferral amount other than zero, you must check 1 and only 1 of the 3 boxes below): [ ] Regular 403(b) deferrals (pre-tax). All of my deferrals as Regular 403(b) deferrals. I understand the amount of deferrals I have elected in this Salary Reduction Agreement will reduce my current compensation which is includible in income for the taxable year of the deferral. [ ] Xxxx 403(b) deferrals (after-tax). All of my deferrals as Xxxx 403(b) deferrals. I understand the amount of deferrals I have elected in this Salary Reduction Agreement will NOT reduce my current compensation which is includible in income and that my deferrals will be includible in income for the taxable year of the deferral. [ ] Split deferral election. A portion of my deferrals as Regular 403(b) deferrals and a portion of my deferrals as Xxxx 403(b) deferrals, as follows (if you check the “Split deferral election” box, complete both blank lines in the following statement): $ _ per pay as Regular 403(b) deferrals, AND $ per pay as Xxxx 403(b) deferrals. (In both blanks indicate at least $5.00 and specify a whole dollar amount. The total must agree with the amount stated in A. above.) I understand: (1) my election regarding the type of deferrals is irrevocable once the employer withholds the deferrals from my pay; and (2) any change of election regarding the type of deferrals is effective only for deferrals from my pay after the plan administrator accepts my change of election. I understand I have a duty to review my pay records (pay stub, etc.) to confirm the employer properly implemented my salary reduction election. Furthermore, I have a duty to inform the plan administrator if I discover any discrepancy between my pay records and this salary reduction agreement. I understand that my failure to report any discrepancy may result in a loss of or reduction in my ability to defer. Signature of Employee (may not be typed name) Date RETURN THIS FORM TO TEAM’S BENEFITS COORDINATOR at xxxxxxxx@xxxx.xxx (Keep a copy for your records) Rec’vd: Effective: GS/Mfile: APS: Cp to payroll: _
Type of deferral. Pre-tax deferrals. All of my deferrals as pre-tax deferrals. I understand the amount of deferrals I have elected in this Salary Deferral Agreement will reduce my current Compensation includible in income for the taxable year of the deferral. Xxxx (after-tax) deferrals. All of my deferrals as Xxxx (after-tax) deferrals. I understand the amount of deferrals I have elected in this Salary Deferral Agreement will NOT reduce my current Compensation includible in income for the taxable year of the deferral.
Type of deferral. The deferrals selected above will be: Regular 403(b) Deferrals (Pre-Tax) Xxxx 403(b) Deferrals (After-Tax)
Type of deferral. I elect to make (if you elected above a deferral amount other than zero, you must check 1 and only 1 of the 3 boxes below): 🞏 Pre-tax deferrals. All of my deferrals as pre-tax deferrals. I understand the amount of deferrals I have elected in this Salary Reduction Agreement will reduce my current Compensation includible in income for the taxable year of the deferral. Xxxx 401(k) 01/2016 🞏 Xxxx (after-tax) deferrals. All of my deferrals as Xxxx (after-tax) deferrals. I understand the amount of deferrals I have elected in this Salary Reduction Agreement will NOT reduce my current Compensation includible in income and that my deferrals will be includible in income for the taxable year of the deferral.
Type of deferral. The deferrals selected above will be: Pre-Tax 401(k) Deferrals Xxxx 401(k) Deferrals (After-Tax) $/% to Pre-Tax 401(k) Deferrals AND $/% to Xxxx 401(k) Deferrals (After-Tax) Duty to Review Pay Records. I understand I have a duty to review my pay records (pay stub, direct deposit receipt, etc.) to confirm the Employer has properly implemented my salary deferral election. Furthermore, I have a duty to inform the Plan Administrator if I discover any discrepancy between my pay records and this Salary Deferral Agreement. I understand the Plan Administrator will treat my failure to report any withholding errors for any payroll to which my Salary Deferral Agreement applies, by the cut-off date for the next following payroll, as my affirmative election to defer the amount actually withheld (including zero). However, I thereafter may modify my deferral election prospectively, consistent with the Plan terms. Acknowledgement/Authorization EXECUTED this day of , 20 .
Type of deferral. I elect to make (if in A above you elected a deferral amount other than zero, you must check 1 and only 1 of the 3 boxes below):
