11/03/15
Agreement for Salary Deferral Under Section 403(b)
BY THIS AGREEMENT, made between (the Employee) and
Clovis Community College we agree as follows:
Effective for amounts paid on or after _______________________, the Employee’s salary will be reduced by the
amount indicated below to the Employee’s 403b contracts which the Employee will allocate among the funding
vehicles approved by the College.
Either party may terminate or otherwise modify this Agreement as of the end of any pay period by giving written
notice that this Agreement will not apply to salary subsequently paid.
____________________________________________________________________________________________
The amount of the salary reduction shall be $__________ per payperiod (24 payperiods per year).
1
This amount
will produce a total contribution that does not exceed the Employee’s statutory limitation under IRC Section 415(c)
or Section 402(g), whichever is less.
For employees age 50 or over, an additional catch up contribution may be included. This amount must not exceed
the statutory limitation under IRC 414(v). The employee hereby agrees to assume sole responsibility for determining
that the maximum amount of salary reduction complies with the limits of internal revenue code sections 403(b),
415(c), 402(g), and 414(v).
____________________________________________________________________________________________
Please select from the authorized vehicles:
American Funds/A10 TIAA-CREF/A60
____________________________________________________________________________________________
Nothing in this agreement shall be deemed to constitute an employment agreement and nothing contained here in
shall be deemed to give the employee any right to be retained in the employ of employer.
______________________ ____________________ ____________________________________
Employee Signature Social Security Number Date
__________________________________________ ____________________
Clovis Community College Human Resource Services Date
____________________________________________________________________________________________
1
This amount should be reviewed with the Human Resource Services Office prior to the execution of this
Agreement.
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