NPERS2500 Rev. 09/2013 Page 1 of 1
BAR CODE
Last First Middle
Name
Date of Birth - -
Plan Type
(Check One)
Social Security Number - - Retirement Number
State
County
Address City State Zip
Home Phone
Work Phone Employer
Investment Election Form
NOTE YOUR ELECTIONS FOR MEMBER FUNDS BELOW.
MEMBER FUNDS INVESTMENT ELECTION (FUTURE ONLY)
You must make your selection in whole increments. The total must equal 100%. Funds are not guaranteed as to rate of return or principal stability. Your employer
and Nebraska Public Employees Retirement Systems are held harmless against any losses in these funds.
% Stable Value (10) % Conservative Premixed (21)
% S & P 500 Stock Index (15)
% Small Company Stock
(16)
% Money Market (13) % Moderate Premixed (23)
% Lg. Co. Gro. Stock Index
(19)
% International Stock (
17)
% Bond Market Index (18) % Aggressive Premixed (22)
% Lg. Co. Value Stock Index
(20)
% Investor Select
(24)
% Age-Based: Age 0-39 (26) % Age-Based: Age 40-59 (27)
% Age-Based: Age 60 & Up
(25)
MEMBER BALANCE TRANSFERS
A transfer will move a dollar amount o
% of your existing membe
funds from one investment fund to another. A transfer between the Stable Value Fund and the
Money Market Fund, which is a “competing fund,” is not allowed.
TRANSFER $ OR % from the FUND, into the FUND.
TRANSFER $ OR % from the FUND, into the FUND.
TRANSFER $ OR % from the FUND, into the FUND.
NOTE YOUR ELECTIONS FOR EMPLOYER FUNDS BELOW.
EMPLOYER FUNDS INVESTMENT ELECTION (FUTURE ONLY)
You must make your selection in whole increments. The total must equal 100%. Funds are not guaranteed as to rate of return or principal stability. Your employer
and Nebraska Public Employees Retirement Systems are held harmless against any losses in these funds.
% Stable Value (10) % Conservative Premixed (21)
% S & P 500 Stock Index (15)
% Small Company Stock
(16)
% Money Market (13) % Moderate Premixed (23)
% Lg. Co. Gro. Stock Index
(19)
% International Stock (
17)
% Bond Market Index (18) % Aggressive Premixed (22)
% Lg. Co. Value Stock Index
(20)
% Investor Select
(24)
% Age-Based: Age 0-39 (26) % Age-Based: Age 40-59 (27)
% Age-Based: Age 60 & Up
(25)
EMPLOYER BALANCE TRANSFERS
A transfer will move a dollar amount or % of your existing employer funds from one investment fund to another. A transfer between the Stable Value Fund and the
Money Market Fund, which is a “competing fund,” is not allowed.
TRANSFER $ OR % from the FUND, into the FUND.
TRANSFER $ OR % from the FUND, into the FUND.
TRANSFER $ OR % from the FUND, into the FUND.
I understand that my funds may not be withdrawn from the plan except in the event of termination, retirement, death or disability.
I authorize the above changes, and certify that the above information is accurate.
Member Signature Date
