ASC 401(k) Enrollment Form

Retirement Plan Enrollment Form
Type of Form*
Employer/Plan Name
General Information
Full Name (Last Name, First Name, MI)*
Social Security Number (Tax ID Number)*
All brokerage firms require this information for new account applicants to comply with IRS regulations.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Date of Hire*

MonthDayYear
Date
E-mail Address*
example@example.com
Marital Status*

Married (Common Law is not recognized as legal marriage)Not Married
Spouse Name
Contribution & Investment Election
In order to have a successful retirement, advisors recommend saving about 10%-15% of gross income for 35 years in an investment that earns about 7.5% a year. Your age and proximity toward retirement should also be considered.
Contribution Type

% Pre-Tax per pay period$ Pre-Tax per pay period% Roth per pay period$ Roth per pay period
% Pre-Tax per pay period
(Your company may limit your election to a percentage option)
$ Pre-Tax per pay period
(As allowed by your employer)
% Roth per pay period
(As allowed by your employer)
$ Roth per pay period
(As allowed by your employer)
Catch-Up

(Check this box if your are 50 or older this year and you wish to contribute up to an additional $6,500 for a total maximum contribution of $27,000 for the 2022 calendar plan year)
Your account will be invested into the default Target Date Profile based on your age. You can change it anytime after your account is open.
Contact the ASC Advisory Team to request for a personalized retirement calculation or a more intensive list of investment options by calling (671) 477-2724 or send an email request to advisory@asctrust.com.
Beneficiary Designation
1. Beneficiary Type
* If you are legally married, you must name your spouse as the sole primary Beneficiary, unless your spouse completes the Spousal consent To Waiver As Primary Beneficiary Form.
Beneficiary Name

First NameLast Name
Beneficiary Date of Birth

MonthDayYear
Date
Share %
Please ensure that the share designation adds up to 100%.
Beneficiary SSN
Relationship
2. Beneficiary Type
Beneficiary Name

First NameLast Name
Beneficiary Date of Birth

MonthDayYear
Date
Share %
Please ensure that the share designation adds up to 100%.
Beneficiary SSN
Relationship
3. Beneficiary Type
Beneficiary Name

First NameLast Name
Beneficiary Date of Birth

MonthDayYear
Date
Share %
Please ensure that the share designation adds up to 100%.
Beneficiary SSN
Relationship
4. Beneficiary Type
Beneficiary Name

First NameLast Name
Beneficiary Date of Birth

MonthDayYear
Date
Share %
Please ensure that the share designation adds up to 100%.
Beneficiary SSN
Relationship
Authorization: By signing below, I acknowledge that I had the opportunity to review the Summary Plan Description and that I understand the provisions of my Employer's Retirement Plan. If I want to make changes to my contribution rate in the future, I can do so by completing a change form or by access my account online.
PARTICIPANT SIGNATURE:

Clear
DATE:

MonthDayYear
Date
A valid Government Photo I.D. / Passport must be uploaded with this request.*

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Retirement Plan Enrollment Form