403(b) and 457(b) Salary Reduction Agreement Form

To submit this form, complete all necessary fields and ensure it is signed. You can fax the form to (800) 597-8206, mail it to National Benefit Services, LLC at 8523 S Redwood Rd, West Jordan, UT 84088, or email it to the provided email address if available. For convenience, make use of our online submission form at www.NBSbenefits.com. Retain a copy of the completed form for your records. It’s important to ensure that all sections are filled out accurately to avoid any delays or issues with the processing of your contributions.

The purpose of the 403(b) and 457(b) Salary Reduction Agreement form is to facilitate employees in managing their contributions to their retirement plans. This form allows employees to establish new salary reductions, make changes to existing contributions, or cancel them altogether. It also serves to inform employees about their responsibilities, the liabilities of National Benefit Services, LLC, and the terms of their retirement plans. The form includes fields for personal information, salary reduction details, and the names of investment providers. Employees are required to sign the form and their financial advisors may also need to provide their contact information. By completing this form, employees ensure that their retirement contributions are managed accurately and in compliance with applicable laws and regulations. Ultimately, this form is a critical tool for employees seeking to optimize their retirement planning. It helps ensure that contributions are directed to the appropriate investment providers and that any desired changes are implemented promptly. By understanding the purpose and properly completing the form, employees can effectively take control of their retirement savings.

• 1. Personal Information: Includes fields for the employee's name, mailing address, city, state, zip code, date of birth, date of hire, company name, email address, phone number, and Social Security number.
• 2. Salary Reduction: Requires the employee to specify the desired amount(s) and investment provider(s) for the salary reduction. The employee must also indicate the type of deferral (Pre-Tax or Roth) and the type of plan (403(b) or 457(b)).
• 3. Financial Advisor/Agent Information: Fields for entering the financial advisor or agent’s name, email address, phone number, and fax number.
• 4. Employee Approval: Section where the employee indicates understanding and agreement to the terms of the Salary Reduction Agreement. The employee must sign and date the form.

Failure to submit this form may result in the inability to set up, change, or cancel salary reductions for your 403(b) or 457(b) retirement plan. This could affect your retirement savings and tax benefits.

• Missed Contributions: Your desired contributions may not be set up, leading to missed opportunities for retirement savings.
• Incorrect Deductions: Failure to update the form may result in incorrect salary deductions that do not align with your current retirement goals.
• Tax Implications: Incomplete or incorrect submissions can lead to adverse tax consequences if contributions are not handled properly.

• 1. Establish New Contributions: Fill out the form to set up initial salary reduction amounts for your 403(b) or 457(b) plan.
• 2. Change Existing Contributions: Use the form to adjust the amount or investment providers of your current salary reductions.
• 3. Cancel Contributions: Submit the form to stop existing salary reduction contributions to your retirement plan.
• 4. Update Investment Providers: If you need to change the providers that receive your contributions, use this form to make the necessary updates.
• 5. Reactivate Stopped Contributions: Fill out the form to restart any previously canceled salary reduction contributions.