DEFERRED COMPENSATION AGREEMENT ELECTION FORM
I hereby elect that my Deferred Compensation Ledger Account balance which is
deemed to be invested in the "PNX Guaranteed Account Option" be paid to me:
[_] In one lump sum payable on the day of , ; or
------- --------- ----
Month Year
[X] In 10 (2-10) annual installments payable on January 15th of each
year.
[_] $________________ annual installment. Remainder to be distributed at
the end of the installment period
[X] Installments of balance beginning January 15, 2003. At the end of the
installment period, zero dollars remain.
BENEFICIARY DESIGNATION
The following are hereby designated as beneficiaries for the purpose of payments
in the event of the death of the Participant prior to the payment of all
benefits under this Agreement:
Primary: Xxxxx Xxxxxxxx
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Contingent: 1/3 each Cengiz, Erol and
Xxxx Xxxxxxxx
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I understand that I may change my beneficiary designation and my investment
election by calling (000) 000-0000 or (000) 000-0000 or by written notice to:
Human Resources, Pension Plan Administration
000 Xxxxxx Xxxxxx Xxxxxxxxx
Xxxxxxx, XX 00000
DEFERRED COMPENSATION AGREEMENT
ACCEPTANCE AND ELECTION FORM
THIS AGREEMENT is solely between Phoenix Life Insurance Company and the
Participant. The Participant and any beneficiaries as designated in this
Election Form, shall have recourse only against Phoenix Life Insurance Company
for enforcement, and it
shall be binding upon the beneficial heirs, assignees, executors and
administrators of the Participant and upon the successors and assigns of
Phoenix.
This election supercedes all previous elections.
EXECUTED by the undersigned this 29th day of August 2002.
PHOENIX LIFE INSURANCE COMPANY
/s/ X. Xxxxxx
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Vice President, Human Resources
/s/ Xxxxx X. Xxxxxxxx /s/ Xxxxxxx Xxxxx
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Xxxxx X. Xxxxxxxx' Signature Witness
