PSW TECHNOLOGIES, INC.
EMPLOYEE STOCK PURCHASE PLAN ("ESPP")
ENROLLMENT/CHANGE FORM
Action Complete Sections:
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SECTION 1: / / New Enrollment 2, 3, 6, 7 AND sign attached
ACTIONS Stock Purchase Agreement
/ / Payroll Deduction Change 2, 4, 7
/ / Terminate Payroll
Deductions 2, 5, 7
/ / Beneficiary Change 2, 6, 7
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SECTION 2: Name _____________________________________________________________________
PERSONNEL Last First MI Dept.
DATA
Home Address______________________________________________________________
Street
_____________________________________________________________________
City State Zip Code
Social Security #: / / / / - / / / - / / / / /
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SECTION 3: Effective with the
NEW Purchase Period Beginning: Payroll Deduction Amount: _____% of
ENROLLMENT base salary*
/ / May 1, 199__
/ / November 1, 199__ * Must be a multiple of 1% up to a
maximum of 15% of base salary
/ / Initial Purchase Period --
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SECTION 4: Effective with the I authorize the following new
PAYROLL Pay Period Beginning: ____________________ level of payroll deduction:
DEDUCTION Month, Day and Year ___% of base salary*
CHANGE
* Must be a multiple of 1% up
to a maximum of 15% of base
salary
NOTE: You may reduce your rate of payroll deductions once per purchase
period to become effective as soon as possible following the
filing of the change form.
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SECTION 5: Effective with the Your election to terminate your
TERMINATE Pay Period Beginning: ___________________ payroll deductions for the balance
PAYROLL Month, Day and Year of the purchase period cannot be
DEDUCTIONS changed, and you may not rejoin
the purchase period at a later
date. You will not be able to
resume participation in the ESPP
prior to the commencement of the
next purchase period.
In connection with my voluntary termination of payroll deductions (or an
approved leave of absence), I elect the following action regarding my ESPP
payroll deductions to date in the current purchase period:
/ / Purchase shares of PSW Technologies, Inc. at end of the period
OR
/ / Refund ESPP payroll deductions collected
NOTE: If your employment terminates for any reason or your eligibility status
changes (< 20 hrs/wk or < 5 months/yr), you will immediately cease to
participate in the ESPP, and your ESPP payroll deductions collected
in that period will automatically be refunded to you.
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SECTION 6: Beneficiary(ies) Relationship of Beneficiary(ies)
BENEFICIARY ---------------- --------------------------------
____________________________________ __________________________________
____________________________________ __________________________________
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SECTION 7:
AUTHORIZATION
I hereby authorize the specific action or actions indicated above.
_________________________ ______________________________________
Date Signature of Employee BPHPA1\ZP\0209738.02
