I hereby request the VEBA Plan to reallocate my current balance(s) and invest any future contributions (if applicable) as per the information I have
provided on this form.
PARTICIPANT ACCOUNT CONTACT INFORMATION
INVESTMENT ALLOCATION CHANGE
REQUIRED PARTICIPANT SIGNATURE
Your handwritten signature is required; e-signatures are not acceptable.
ACCOUNT NUMBER or SSN DATE OF BIRTH MM/DD/YYYY
LAST NAME FIRST NAME M.I.
E-communication is fast and convenient. Electronic documents may include your Plan Summary, participant account statement and
explanation of benets (EOB) notications, and general communication. If you are electing e-communication, please note that after logging in
to your account at veba.org, you (1) may withdraw your consent for electronic documents at any time without charge by updating your account
preferences; (2) will be able to view and print copies of electronic documents (you may request paper copies at no charge by contacting the
customer care center); and (3) can update your email address on le by updating your personal information. To access electronic documents,
you will need a copy of Adobe Acrobat Reader software loaded on your computer. You can download and install a free copy at www.adobe.
com. Documents provided electronically will not be mailed via U.S. Mail.
MAILING ADDRESS CITY STATE ZIP
AREA CODE and PHONE NUMBER EMAIL ADDRESS (use home or personal email address)
Select and complete this option if you want your asset
allocation portfolio designed and managed by professionals.
Choose only one pre-mix. If you select multiple funds your
entire account will be invested in the most conservative fund
selected. Read the Investment Fund Information brochure
available online at veba.org for more information.
The pre-mixed asset allocation portfolios are managed
to stay on their respective target allocations. Each fund
maintains its growth- or income-oriented asset mix; you
never have to rebalance to keep your selected strategy on
Fund Name Risk Target Allocation
PARTICIPANT SIGNATURE DATE MM/DD/YYYY PHONE NUMBER WHERE I CAN BE REACHED
If you have more than one participant account, enter the participant account number of the account to which you want your revised investment
allocations to apply. Otherwise, your investment allocation changes below will be applied uniformly to all of your accounts.
Select and complete OPTION A or OPTION B, but not both. You should carefully read the Investment Fund Information brochure available at
veba.org or upon request from the customer care center. If you have more than one participant account and submit an Investment Change form
without entering a participant account number, your requested change will be applied to each of your participant accounts. If you do enter a participant
account number on the form, your investment allocation change will apply only to the specied account.
Select and complete this option if you want to build your own portfolio.
Enter only whole numbers—no fractions. Your allocation must
equal 100%. Allocations that are not whole numbers will be rounded
to the nearest whole number. Generally, if your allocation exceeds
100%, the excess will be subtracted from your least conservative fund
choice. If your allocation is less than 100%, the shortage will be added
to your most conservative fund choice.
Rebalance my allocation percentages:
(end of each calendar quarter/year)
Rebalancing is an important feature that will redistribute your
entire account balance according to your most recent allocation
percentages on le. If selected, this option will continue until revoked
online or via written notice to the Plan.
Asset Class / Fund Name
Stable Value / GSAM Separate Account %
Total Return Bond / Metropolitan West Total Return Bond %
Large Cap Equity / Vanguard Institutional Index (S&P 500) %
Mid Cap Equity / Scout Mid Cap %
Small Cap Equity / Champlain Small Company %
International Equity / American Funds EuroPacific Growth %
Total Must Equal 100% u
VP48 (12/14 PRC)
1-888-828-4953 | |
Skip this form! Log in at and submit your investment change online.
| Fax: (206) 577-3020 | VEBA Plan, PO Box 80587, Seale WA 98108