Common Contracts
1 similar Salary Deferral Agreement contracts
Salary Deferral Agreement Concordia Retirement Savings PlanSalary Deferral Agreement • November 10th, 2011
A PARTICIPANT INFORMATION Name (Last, First, Middle Initial) Date of Birth (MM/DD/YYYY) Social Security Number Address City State Zip Code Home Phone Number E-mail Address Cell Phone Number Work Phone Number Under IRS 403(b) regulations effective 1/1/2009, employers have administrative and compliance responsibilities that require the following information:• Total amount contributed through payroll deductions to any 403(b) provider(s) during the 2012 calendar year (exclude Concordia Retirement Savings Plan contributions with current employer) $ .• If you have authorized payroll deductions to any 403(b) provider between 1/1/2005 and 12/31/2008, please list provider name(s): • Do you have any outstanding 403(b) loans with Concordia Retirement Savings Plan or another provider? □ Yes □ No If yes, do you need payroll deductions set up to repay the loan? □ Yes □ No• Have you taken a 403(b) Hardship Withdrawal in the past 6 months? □ Yes □ No If yes, what was the date of the withdrawal? No
