Participant Enrollment/Investment Election Form
E.K.G. Security, Inc. Retirement Plan
PARTICIPANT INFORMATION:
Employee First Name
Employee Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Security Number
Date of Hire
-
Month
-
Day
Year
Date
Marital Status
Please Select
Married
Single
CONTRIBUTION ELECTION:
Please choose at least one option below
Elective Deferrals:
I elect to participate and contribute the amount noted below per pay period on a Pre-Tax basis (Maximum: up to the IRS deferral limit)
I elect to participate and contribute the amount noted below per pay period on a ROTH basis (Maximum: up to the IRS deferral limit)
I elect not to make elective deferrals until further notice. I understand that if I do not participate now, or discontinue participation, must wait until the next available enrollment date. Although I elect not to save through payroll deduction, I understand my employer may elect to contribute a discretionary contribution to the Plan, and I authorize such a contribution to be invested as indicated below.
Catch-up Contributions
I will be at least 50 years of age or older by the end of the calendar year and elect to make catch-up contributions to the Plan. See the Plan Administrator for details on how to make these catch-up contributions. (Maximum: up to the IRS deferral limit)
Contribution Amounts
Contribute
% or $
on a Pre-Tax Basis.
Contribute
% or $
on a ROTH Basis.
INVESTMENT ELECTION:
I authorize all contributions to be invested as follows: (Must equal 100%)
% of Deferral to Invest
(Must be Whole Percentages)
Schwab Savings Bank RBS1CSBS
BlackRock Sh-Term Municpal 09253C793
Fidelity Adv China Region 31618H325
Fidelity Adv Convertible Sec 316145796
Fidelity Adv Floating Hi Inc 315806703
Fidelity Adv Gold Z 316390178
Fidelity Adv Emerging Markets 31618Q507
Fidelity Emerging Markets 316146331
Fidelity Global Ex US Idx 31614315
Fidelity Inflation-Prot Bd Idx 31635T104
Fidelity Interm Trs Bd Idx 31635V257
Fidelity Intl Index 315911727
Fidelity Lg Cap Growth Index 31635V729
Fidelity Lg Cap Value Index 31635V679
Fidelity Long Term Trs Bd 31635V232
Fidelity Mid Cap Index 316146265
Fidelity Mid Cap Value Idx 31635T799
Fidelity Real Estate Indx 316146232
Fidelity Short Term Bond Idx 31635V273
Fidelity Small Cap Growth Idx 31635T781
Fidelity Sm Cap Index 316146182
Fidelity Small Cap Value Idx 31635T773
Fidelity Total Market Index 315911693
Fidelity US Bond Index 316146356
iShares Developed Real Estate 091936187
Schwab 1000 Idex 808517106
Schwab S & P 500 Index 808509855
Vanguard Comm Strategy Adm 921939708
Vanguard Emerging Market Bd 922020821
Vanguard Energy Index Adm 92204A843
Vanguard Global Wellesley Inc 921910741
Vanguard Global Wellington Adm 921910766
Vanguard Health Care Idx Adm 92204A827
Vanguard High Yield Corp Adm 922031760
Vanguard Info Technology Idx 92204A793
Vanguard Interm Term Inv Gr Adm 922031810
Vanguard Long Term Inv Gr Adm 922031778
VG Total Bond Mkt Idx Admiral 921937603
Vanguard Utilities Inx Adm 92204A769
Fidelity Mid Cap Growth Idx 31635T815
SIGNATURES:
Participant Signature
Date
-
Month
-
Day
Year
Date
Plan Administrator Signature
Date
-
Month
-
Day
Year
Date
For more information on your Plan, you can call 888.542.4015 or access the Internet site at www.401kpal.com.
Submit
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