ASC Retirement Plan Enrollment Form

Retirement Plan Enrollment Form
Type of Form*
How did you receive this enrollment form?
Employer/Plan Name*
General Information
Name*

First NameMiddle NameLast Name
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
Home Phone *

Area CodePhone Number
Office Phone

Area CodePhone Number
Other Phone

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*

First NameLast 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.
Deferral Type
Contribution Format
Contribution Type

Pre-TaxRoth
% 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)
Annual Auto Increase

Automatically increase contributions by 1% annually until 15% is reached.
Contribution Amount
Your account will be invested into the default Target Date Profile based on your age and projected years to retirement. You can change it anytime after your account is open.

The ASC Select Target Date Series Profile Trust Funds (TDP) is a hybrid strategy allocated 50% to passively managed Fidelity Funds and 50% to actively managed American Funds. The funds' glidescope path, as well as the fund allocation percentages are effective January 1, 2017, and are subject to the ASC investment Committee oversight, as well as both American Funds' and Fidelity Funds' management discretion. Further, each will evolve over time as the specific fund nears its target date.

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.
I understand that this allocation will apply to:

Future Contributions OnlyFuture Contributions and Existing BalancesExisting Balances Only
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*
5. 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*
If no beneficiaries are listed above, please note the following default beneficiary designation.

Upon my passing, 100% of my retirement benefit will be paid in the following order of priority to:
1. If I am legally married (common law is NOT recognized as legal marriage), my surviving spouse, unless my spouse completes the Spousal Consent to
Waiver as Primary Beneficiary Form.
2. If I am not legally married or if my spouse is deceased or ineligible to receive my benefit, my surviving children (including all legally adopted children) will
receive my benefit in equal shares.
3. My surviving parent(s) in equal shares.
4. My estate.
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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