Before you complete this form, please read the accompanying literature in
the 457 Enrollment Kit to ensure you understand the plan’s provisions.
After your account at ICMA-RC has been established, you can make future
changes to your account, such as address changes and/or fund transfers,
using Account Access (www.icmarc.org) or by calling Investor Services
at 800-669-7400. To change your name, marital status, or beneficiary
designation, please use the Employee Information Change Form. You can
download this form by accessing our Web site at www.icmarc.org/forms.
Once your enrollment is complete, you will receive a Welcome Letter from
ICMA-RC confirming your account information. In addition, you will receive
quarterly statements for your account. Please review these items carefully
and notify ICMA-RC immediately of any errors.
IMPORTANT NOTE: Please do not delay in submitting this form to your
employer. If we do not have your form by the time we receive your first
deferral, we will be unable to invest your retirement plan assets, and they
will be returned to your employer.
1. PARTICIPANT INFORMATION – Please complete this section carefully.
The information will be used to establish your account. If you do not know
the employer plan number, it is available from your employer or ICMA-RC’s
Investor Services at 800-669-7400.
2. BENEFICARY DESIGNATION – Print the name, date of birth, relationship to
you, Social Security number, and percentage to be received for each of your
beneficiaries. The beneficiary relationship options are spouse, non-spouse,
trust, and charity. If this form is not signed, the beneficiary designation will
not be valid. If a valid form is not on file at the time of your death, benefits
will be paid as outlined in your employer’s plan document (normally, to your
estate).
Beneficiary percentages are invalid if your request omits percentages,
included percentages that do not equal 100%, or is expressed with fractions
(e.g., 33
1
/3%).
For future updates to your beneficiary information, please use the Employee
Information Change Form. You can download this form by accessing our
Web site at www.icmarc.org/forms. Please note that beneficiary information
cannot be updated over the phone.
The IRS has certain rules governing the distribution of funds to beneficiaries.
These rules are outlined in your employer’s plan document and ICMA-RC’s
Participant and Beneficiary Withdrawal Packets.
More than three beneficiaries – You are not limited to three primary and three
contingent beneficiaries. To designate additional beneficiaries, (1) write “see
attached sheet” on the primary and/or contingent beneficiary line(s) under
“Name” and (2) attach and sign a separate piece of paper with your name,
plan number, Social Security number, and additional beneficiary information.
If none of your primary beneficiaries are living upon your death, your assets
will be distributed to your estate unless you have a designated contingent
beneficiary.
Note: If a Social Security number is not provided for your beneficiary(ies)
and ICMA-RC cannot locate the named beneficiary(ies), the account balance
will be paid as outlined in your employer’s plan document (normally, to your
estate).
SPECIAL CERTIFICATION FOR PARTICIPANTS IN COMMUNITY PROPERTY
STATES – If you are married and live in a community property state (AZ,
CA, ID, LA, NV, NM, TX, WA, or WI), you must generally name your spouse
as your beneficiary unless your spouse waives this right. ICMA-RC cannot
be responsible for an employee’s failure to properly designate a beneficiary
in accordance with state law requirements and the employee’s failure to
provide the certification required by this enrollment process. Please be
advised that failure to meet state law requirements with respect to your
beneficiary designation may result in your beneficiary designation being
invalid, and the payment of benefits to someone other than your intended
beneficiary(ies). If you choose to name a beneficiary that is not your spouse,
you and your spouse will need to complete the Community Property Spousal
Waiver Form. Contact 800-669-7400 for more information and to request the
waiver form.
3. AMOUNT OF DEFERRAL – IRS regulations allow you to defer the
lesser of (1) a dollar limit in effect for that year, or (2) 100% of your gross
compensation less any mandatory pre-tax (“picked-up”) employee 401 plan
contributions. If you are age 50 or older, you may make additional annual
catch-up contributions of a dollar limit in effect for that year. In addition,
the “Pre-Retirement” catch-up provision allows eligible participants to
contribute additional amounts during the three years prior to the calendar
year of their declared normal retirement age. Please review the 457 Deferred
Compensation Plan Catch-Up Provision Packet to determine your eligibility.
You may obtain the packet on our Web site at www.icmarc.org/forms. For the
applicable dollar limits, please log on to www.icmarc.org or contact Investor
Services at 800-669-7400. You may increase, decrease, stop, or restart
contributions by executing appropriate forms. The change will be effective,
if practical, the first pay period of the calendar month commencing after the
date the amendment is executed.
4. ALLOCATION OF CONTRIBUTIONS – Your contributions can be invested
in one or more funds available to your plan (your employer may place
restrictions on investment in certain funds). Use whole percentages for
your allocations (e.g., 50%, not 33
1
/3%). Do not use fixed dollar amounts.
Please read Making Sound Investment Decisions: A Retirement Investment
Guide and the appropriate prospectus for full descriptions of the funds. If
no allocation instructions are provided, the percentages do not total 100%,
or the allocation instructions are invalid, assets will be allocated to the
default investment selected by your employer until additional instructions
are received from you. Review the Notice Regarding Default Investments
included in the 457 Enrollment Kit for more information.
PLEASE NOTE: The allocation instructions you provide will affect payroll
contributions only. To specify the allocation for any rollover contributions
from another eligible retirement plan, please contact ICMA-RC for the
appropriate transfer form that will provide instructions on establishing
a rollover allocation. In the absence of rollover allocation instructions,
incoming rollover assets will be invested in your payroll contribution
allocation, or in the default investment selected by your employer if your
contribution allocation is not established.
Participants residing in New York State will have their investment
allocated according to their payroll contribution allocation, per New York
State plan rules.
ICMA-RC Services, LLC, the wholly owned broker-dealer subsidiary of ICMA-
RC, is a member of the Securities Investor Protection Corporation (SIPC).
SIPC is an agency that insures certain investors against losses due to the
financial failure of brokerage firms. For more information regarding the SIPC,
including the SIPC brochure, please visit the SIPC Web site at ww.sipc.org or
call 202-371-8300.
5. AUTHORIZED SIGNATURES – Once you have completed this form, sign it
and submit it to your employer for approval. If this form is faxed (202-682-
6439) to ICMA-RC, please do not mail the original.
Note that by signing this form you acknowledge that you agree to the
following disclosure:
I have received and read the current VantageTrust Company’s Making Sound
Investment Decisions: A Retirement Investment Guide and the appropriate
prospectus. I understand that ICMA-RC has established required procedures
for Internet and telephone transfers that include personal identification
numbers, recording of instructions, and written confirmations. In the event
I choose to transfer funds by Internet or telephone, I agree that neither the
VantageTrust Company, ICMA-RC, ICMA-RC Services, LLC, nor Vantagepoint
Transfer Agents, LLC, will be liable for any loss, cost, or expense for acting
upon any Internet or telephone instructions believed by it to be genuine and
in accordance with the required procedures.
An authorizing signature does not represent an obligation to use the Internet
and telephone transfer feature.
Welcome to ICMA-RC!
457 deferred compensation pLan empLoYee enroLLment form instrUctions
FRM570-004- 0408-2144-01
