How Do I Complete an Enrollment Application?

The Plan provides a fillable enrollment application to directly type your information onto this form or print it to be completed by hand. You must sign and submit this form through the mail for processing to participate in the Plan.

Enrollment Form (PDF – fillable)

Enrollment Form (PDF – non-fillable)

Here are some basic instructions to help you complete the enrollment form and begin investing for your retirement.

Section I – PERSONAL DATA

• Enter all of your personal information in the fields provided
• Enter your employer’s ID number in the boxes provided
• If you do not know your employer’s number, the HELPLINE can assist you

Section II – BENEFICIARY ELECTION

• Enter the personal information of your primary and contingent beneficiaries
• Indicate the percentage payable to each beneficiary, in whole numbers – totals must equal 100%
• Please complete the form accurately and legibly

Section III – DEFERRAL INFORMATION

• Write the amount you wish to contribute for either or both pre-tax deferrals and Roth contributions
• Please call the HELPLINE to see if your employer offers the Roth option
• Minimum deferrals cannot be less than 1% of your gross salary or less than $10 per pay period. Learn more about maximum contribution limits, which may vary from year to year.

Section IV – DEFERRAL ALLOCATION

• Designate the percentage you wish to allocate to each investment option, in whole numbers – total must equal 100%

Section V – PAPERLESS STATEMENT OPT OUT

• If you wish to opt out of paperless statements, check box to receive information by regular mail.

Section VI – AUTHORIZATION

• Sign and date the enrollment form
• Send the form to the address indicated on the enrollment form

Get the help you need

If you need help filling out the form or understanding investment options, please call the HELPLINE.

PDFs require Adobe^® Reader^®