The Salary Reduction Agreement (SRA) is utilized to establish, change, or cancel salary reductions withheld from your paycheck and contributed to the
403(b) Plan on your behalf. The SRA is also used to change the investment providers that receive your contributions. Upon completion, fax or mail a
copy of the form to National Benefit Services, LLC. Please note that this form is not valid unless all applicable sections are completed and you have
signed the form. If you have questions regarding this form, please call 1-800-274-0503 ext 5.
Upon completion, fax (1-800-597-8206), email, or mail a copy of the form to National Benefit
Please allow 5 business days for processing. Salary Reduction Agreements received less than 5 business days prior to the SRA due
date are not guaranteed to be processed for that SRA due date.
The Employee agrees to indemnify and hold the Employer and National Benefit Services, LLC (NBS) harmless against any and all actions, claims, and
demands that may arise from the purchase of annuities or custodial accounts in this 403(b) Plan. The Employee acknowledges that neither the
Employer nor NBS have made representation to the Employee regarding the advisability, appropriateness, or tax consequences of the purchase of the
annuity and/or custodial accounts. The Employee agrees that neither the Employer nor NBS shall have any liability for any and all losses suffered by
the Employee with regard to his/her selection of the annuity and/or custodial account; its terms; the selection of the insurance company or regulated
investment company; the solvency of, operation of, or benefits provided by said insurance company or regulated investment company; or his/her
selection and purchase of shares of regulated investment companies.
The Employer reserves the right to alter terms of this Agreement as required to facilitate program compliance with state and federal law.
The Employer does not choose the annuity contract or custodial account in which the Employee's contributions are invested.
The Employee is responsible for setting up and signing the legal documents to establish the annuity contract or custodial account.
In order for the Employee to receive the expected tax results, the annuity contract or custodial account established must meet the requirements of
Section 403(b) of the Internal Revenue Code. It is solely the Employee’s responsibility to establish the proper type of contract or account for this
The Employee is responsible for naming a death beneficiary under the annuity contract or custodial account. This is normally done at the time the
contract or account is established, although the designation should be reviewed from time to time.
The Employee is responsible for investment decisions, distributions, and any other transactions with the insurance company or investment company
and shall have total responsibility for all distributions and any resulting tax consequences. All rights under the contract or account are enforceable
solely by the Employee, the Employee’s beneficiary, or the Employee’s authorized representative.
The insurance or investment company may be required to receive approval from the Employer or National Benefit Services, LLC, prior to executing
certain transactions including loans, hardships, distributions, or transfers (as permitted by the Plan).
The Employee understands that information contained in this Agreement and other non-public information may be shared with the Employer's
designated third-party administrator in conjunction with the operation of the 403(b) Plan.
Retain a copy of this form for your records.