Form 21388 - Compensation Plan Participation Agreement And Contract Change Form

ADVERTISEMENT

Section 457 Deferred Compensation
Plan Participation Agreement and
The Lincoln National Life Insurance Company
Contract Change Form
PO Box 2340
Fort Wayne IN 46801-2340
(also use for 457(e)(11) LOSAP)
Phone 800-4LINCOLN (800-454-6265)
* You may use this form for 457(b) and 457(e)(11) markets.
Plan Information
Plan name
Contract no.
Group no.
Initial enrollment
Reenrollment
Information change
Participant
Name
Information
Social Security number
Date of birth
Address
City, State, ZIP
Deferral Amount
* The beginning date cannot be earlier than the calendar month following the date this form is
signed by the participant.
Amount of deferral
Dollar amount $______________
Percent of salary _______%
Annual salary $ ____________________
Date deferral begins ______________________
Is the catch up provision applicable?
Yes
No
Future deferrals only
Reallocation of existing
Allocation
investments only
Information
Amount per deferral
Group Fixed Annuity
$ _____________
Use whole percentages
If reallocating
Multi Fund
®
$ _____________
existing investments,
you must also
Fund name
From
To
complete the Future
____________%
________________________
_____________$/%
_____________$/%
deferrals column.
____________%
________________________
_____________$/%
_____________$/%
____________%
________________________
_____________$/%
_____________$/%
____________%
________________________
_____________$/%
_____________$/%
____________%
________________________
_____________$/%
_____________$/%
100
%
Total
____________
Beneficiary
You designate the following beneficiaries in accordance with the plan document. If you wish to
designate more than one beneficiary, provide the information on a separate sheet.
Information
Primary’s name
Soc. Sec. no.
For employer/plan
administrator use
Relationship
%
only.
Contingent’s name
Soc. Sec. no.
Relationship
%
Signatures
By signing below, you understand and agree to the selections or changes you have made.
Participant’s signature
Date
Employer/Plan
administrator’s signature
Date
Representative’s signature
Date
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Lincoln Retirement is the marketing name for the
annuities operation of The Lincoln National Life Insurance Company.
Form 21388 12/04
Copy 1 - Employer/Plan Administrator
Copy 2 - Lincoln Retirement
Copy 3 - Representative
Copy 4 - Participant

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Florida Municipal Pension Trust Fund 457(b) Deferred Compensation Plan Participation Agreement Florida Municipal Pension Trust Fund 457(b) Deferred Compensation Plan Participation Agreement Business
Student Ministries Participation Agreement And Medical Release Student Ministries Participation Agreement And Medical Release Legal
Pathway Community Church (pcc) Rental Agreement And Contract Template Pathway Community Church (pcc) Rental Agreement And Contract Template Business
Participant Agreement, Indemnification, Release And Waiver Of Liability And Assumption Of Risk Participant Agreement, Indemnification, Release And Waiver Of Liability And Assumption Of Risk Legal
Participant Waiver And Release Of Liability And Assumption Of Risk Agreement Participant Waiver And Release Of Liability And Assumption Of Risk Agreement Legal
Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents Financial
Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents (ohio Revised Code 5731.39) Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents (ohio Revised Code 5731.39) Financial
Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefits And Retirement Plans For Resident And Nonresident Decedents Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefits And Retirement Plans For Resident And Nonresident Decedents Financial
Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents Form Et 13 - Application For Consent To Transfer The Proceeds Of Insurance Contracts, Employer Death Benefi Ts And Retirement Plans For Resident And Nonresident Decedents Financial
Participant Agreement Release And Liability Waiver Form Participant Agreement Release And Liability Waiver Form Legal

Related Categories

Parent category: Business
Download
Go