NRM-17111M1-OH.1 (03/19)
Personal information (please print)
EZ Enrollment Form
TERMS AND CONDITIONS
Upon enrolling, you will be mailed a Welcome Kit that includes the Cancellation
Form, Beneficiary Form, Memorandum of Understanding, and Plan Document
with more detailed information on the terms and conditions outlined below:
• Your account balance will be held by Ohio Deferred Compensation
in trust on behalf
of your employer for the exclusive benefit of you
or your beneficiaries.
• You can cancel your participation before your forms are processed by calling
877-644-6457 within seven days of the signature date on this form.
• Based on market fluctuations, the rate of return on your account could
be either positive or negative. This could result in your account balance being
worth less than your contributions.
• I nvestments have underlying expenses or management fees that will reduce the
i nvestment results. Information on these expenses can be
found in the fund profiles or the respective prospectus. Call 877-644-6457 to
request the fund profile or prospectus.
• Before investing, carefully consider the fund’s investment objectives,
risks, charges, and expenses. The fund prospectus or profile contains
this and other important information. Read the prospectus or profile carefully
before investing.
• At any time, you may change the amount you defer or the allocation
of future i nvestment options.
• The Internal Revenue Service imposes rules that limit the times you
can make changes or receive withdrawals from the Program.
• You may withdraw funds from the Program only upon:
1. Ending your employment (including termination, retirement, or death)
2. An Unforeseeable Emergency (as defined by Section 457 of the IRC)
3. S
mall Balance Distribution (see Plan Document for eligibility)
• An Unforeseeable Emergency is defined by the IRS as a severe financial
hardship. Please see the Program Plan Document for specific details. Purchasing
a home, credit card debt, and sending your children to college are not
qualifying events.
• Withdrawals may begin after ending your employment and the Program’s
receipt of your employer’s verification that employment ended, final deferral,
and the Withdrawal Election form.
• Distributions must satisfy certain minimum requirements upon
attaining age 70 1/2.
• The funds in your account may be eligible for rollover to a traditional IRA
or to an eligible retirement plan upon ending your employment.
• Your participation in Ohio DC is for long-term retirement savings. You should
maintain separate, available emergency funds to cover day-to-day,
unanticipated, financial shortages.
Remember, there are no guarantees. Investing involves risk, including
possible loss of principal.
Account Executives are registered representatives of Nationwide
Investment Services Corporation, Member FINRA.
TURN IN TODAY!
Fax: 614-222-9457
Mail: 0hio Deferred Compensation
257 East Town Street, Suite 457
Columbus, Ohio 43215-4626
/ /
Social Security number (required)
I acknowledge I have read the terms and conditions.
——
_________________________________________________________________
Last name First M.I.
_________________________________________________________________
Address
_________________________________________________________________
City State Zip
_________________________________________________________________
Email
______________________________ ______________________________
Work phone Personal phone
______________________________
Male Female
Birth Date (mm/dd/yyyy)
_________________________________________________________________
Employer name
______________________________________________ _______________
Department Pay days per year
Pension system:
OPERS STRS SERS OP&F HPRS
CINCY OTHER
I currently have other tax-deferred retirement assets in (check any that apply):
457 401(k) 401(a) 403(b) Traditional IRA None
______________________________________________ _________________
Signature Date (mm/dd/yyyy)
/ /
Make your choice
I would like to invest in my future by enrolling
in the Ohio Deferred Compensation saving plan
today and begin contributing per pay period:
$50 $100 Other: $
A pre-tax deduction will be invested in a LifePath
Portfolio closest to the year I turn 65. My payroll
deductions will begin on the next pay period following
30 da
ys from the date my form is received by Ohio DC.
You will be enrolled in the SMarT plan to automatically
increase your deferrals each January by $10 per pay or
$ per pay. Check the box to decline the
benefits of the SMarT plan.
You will be notified when your Quarterly Statements
and Focus newsletters are available at Ohio457.org.
If you prefer to receive your statements and
newsletters by regular mail, please check the box.
