401(K) PLAN ENROLLMENT FORM Employee Name Effective Date
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1 401(K) PLAN ENROLLMENT FORM Employee Name _ Effective Address City St Zip Social Security No. of Birth of Hire Marital Status: Married Unmarried New Participant Election Change of Election SECTION I (A) ELECTION TO PARTICIPATE PARTICIPATION ELECTION I hereby direct my employer to withhold through payroll reduction, and contribute to my account, the following percentage of my gross compensation: 1% 2% 3% 4% 5% 6% Other (B) ELECTION NOT TO PARTICIPATE I do not want to participate in the Plan at this time. I understand that I may change this election by submitting a new Enrollment Form. (C) CANCELLATION Please discontinue my contribution to the Plan. I understand that I will be able to resume my contributions on the next available Plan Entry. SECTION 2 INVESTMENT OPTIONS (A) NEW CONTRIBUTION INVESTMENT ELECTIONS I direct my contributions to be invested in the funds selected below. I understand these elections will remain in effect until I execute a new Enrollment Form. % Money Market Fund % Bond Fund of Mahi Mahi % Tahiti Balanced Fund % Investment Co. of Mexico % Growth Fund of Columbia % Gamecock Balanced Portfolio % Super Growth Fund (B) ACCOUNT BALANCE CHANGE ELECTIONS I direct my balances to be invested in the funds selected below. Funds will be transferred within 30 days after the next Fund Transfer following the receipted date of this form. % Money Market Fund % Bond Fund of Mahi Mahi % Growth Fund of Columbia % Tahiti Balanced Fund % Husky Balanced Portfolio % Investment Co. of Mexico % Super Growth Fund NOTE: ELECTIONS MUST TOTAL 100% AND PERCENTAGES MUST BE IN 10% INCREMENTS ONLY! Participant Signature: d: Authorized Signature: d: BENEFICIARY CHANGE FORM ON BACK.
2 DESIGNATION OF BENEFICIARY Participant Name _ SS# Address City State Zip I revoke all previous Beneficiary Designations made by me with respect to this Plan, and I direct that all benefits to which I may be entitled under this Plan shall be paid upon my death as follows: PRIMARY BENEFICIARY NAME/ADDRESS SS# RELATIONSHIP BIRTHDATE CONTINGENT BENEFICIAR (IES) NAME/ADDRESS SS# RELATIONSHIP BIRTHIDATE By executing this Designation of Beneficiary Form, I hereby acknowledge that: 1. Benefits payable hereunder shall be paid according to the directions noted above. If any Primary Beneficiary should predecease me, the share of each remaining Primary beneficiary shall be increased proportionately. If no Primary beneficiary survives me, then payment shall be made in equal shares (or as otherwise indicated above) to the contingent Beneficiary(ies). If any Contingent Beneficiary predeceases me, the share of the remaining Contingent Beneficiary(ies) shall be increased proportionately. 2. This Beneficiary Designation shall be effective only if received by the trustee prior to my death. 3. This Designation of Beneficiary is subject to any applicable requirements of the qualified joint and survivor annuity or qualified preretirement survivor annuity provisions of ERISA. I understand that this Designation of Beneficiary will be null and void if I have named a beneficiary other than my spouse unless my spouse has consented below to the specific designation. 4. I have the right to change by Beneficiary(ies) by filing a new Designation of Beneficiary subject to my spouse's consent, if required. d, 19. Witness Signature of Participant
3 CONSENT OF SPOUSE I,, the undersigned spouse of the above-named Participant, have read this Designation of Beneficiary Form and hereby consent to such beneficiary designation, including all Primary and Contingent Beneficiaries. I understand that by consenting to this Designation, I may be waiving my right to receive a benefit under the Plan in the event of my spouse's death. I have signed this consent freely and voluntarily. I understand that I may not revoke this consent, except by consenting to another Beneficiary Designation executed by the Participant. BEFORE ME, the undersigned Notary Public, personally appeared and executed the above Consent of Spouse. Signature of Spouse IN WITNESS WHEREOF, I have signed my name and affixed my official seal of office on, 19. Notary Public - State of My commission expires:
4 DISTRIBUTION REQUEST / DIRECT ROLLOVER FORM Plan # & Name: / Corporation and Subsidiaries 401 (k) Plan Employee Name: _ SS#: Home Address: of Birth: City/State/Zip: Daytime Phone #: of Termination: Location #: I have read and understand the distribution options available to me under this plan as explained in the Special Tax Rules Relating to Distributions printed on the back of this form or provided by the Plan Administrator. [ ] I elect a direct rollover option and hereby, represent that the new plan to which I direct my distribution to be paid, is a qualified plan. I understand the check will be made payable to the Trustee, but will be mailed to me and it is my responsibility to deliver it to the new Trustee. Please make my check payable to the following: [ ] Qualified Retirement Plan OR [ ] Individual IRA Trustee Name Trustee Address City, State, Zip OR [ ] I elect not to rollover my distribution into an IRA or a qualified retirement plan. I have been notified by the Plan Administrator of my options and am aware of my tax liabilities and any applicable penalties for withdrawal. I understand that 20 % in federal taxes will be withheld and forwarded to the IRS on my behalf. Employee Signature Spouse Signature (Must be Notarized) Notary Public 401 (k) Administrator Approval
5 SPECIAL TAX RULES RELATING TO DISTRIBUTIONS The Internal Revenue Code ("Code") provides several complex rules relating to the taxation of the amounts you will receive in this distribution. This material is merely a general description and summary of these rules as of the date this material was prepared and is not to be construed as a recommendation as to the course you should follow. You will also receive a notice with additional details as to your options under the tax rules governing rollovers. The tax consequences of this distribution may be affected by amendments to the Code which may be enacted and by the particular facts and circumstances of your situation. You are strongly urged to consult your tax adviser with respect to the tax consequences to you before deciding what course to follow. ROLLOVERS The Code permits you to avoid current taxation on any portion of the taxable amount of an eligible rollover distribution by rolling over that portion into another eligible retirement plan that accepts rollover contributions or into an individual retirement arrangement ("IRA"). Please note that the amount of employee after-tax contributions included in the distribution are not generally eligible to be rolled over. A rollover can be accomplished either by direct rollover to the plan or IRA or by your transferring the amount you are rolling over to the new plan or IRA not later than 60 days after you received the amount from this plan. You should notify the trustee or issuer of the new plan or IRA that you are making a rollover contribution. Tax withholding rules will depend on whether or not your distribution is eligible to be rolled over and the manner in which you make the rollover. If the distribution is not eligible for rollover, voluntary withholding rules will apply and you will be provided with notice of your ability to elect out of withholding. If a direct rollover is made, no tax withholding applies. If, however, you receive a rollover eligible distribution, mandatory 20% tax withholding will apply, even if you intend to rollover the funds within sixty days. If you do not properly roll over your distribution, you will be currently taxed on it at ordinary income tax rates. Unless you receive the distribution after you reached the age of 59 1/2, you will be subject to an additional tax equal to 10% of the taxable portion of the distribution, unless an exception applies. See the discussion entitled "Premature Distributions" below for additional information. Finally, if 20% withholding applies to your distribution, you will be subject to current taxation on the 20% amount withheld if you only rollover the 80% balance received. To avoid taxation on the 20% amount withheld you will need to replace this amount with your own funds sot hat 100% of the eligible rollover distribution is in fact rolled over- You can then seek a refund or credit for any amounts withheld when filing your tax return. SPECIAL TAX RULES If your distribution qualifies under the Code as a lump sum distribution and no part of this distribution or any prior distribution from the plan is or has been rolled over, you may be able to elect special income averaging rules that may reduce the amount of income tax you will be required to pay on account of this distribution. A lump sum distribution is a distribution from a qualified plan of your entire interest in the plan within one taxable year that is made because of your separation from service, death or your reaching age To qualify for special income average, the employee must have attained age 59 1/2 and have participated in the plan for at least five years prior to the time of this distribution. In general, the special 5-year averaging rules treat the amount received as if it were spread out over five years. The special 5-year averaging rule generally may not be used unless you are age 59 1/2 at the time of the distribution and it may be used only once. Special rules apply if you reached age 50 by January 1, You may in general (1) elect to use the special 5-year averaging rules whether or not you have reached age 59 1/2, using the income tax rates in effect in the year of the distribution or I 0-year averaging under pre-1986 tax rules. using the 1986 income tax rates and (2) elect to treat a portion of the lump sum distribution allocable to pre-1974 participation in the plan as capital gain subject to tax at a 20% rate. Only one election is available per individual If you make this election, you lose the ability to elect 5-year averaging and capital gains treatment again after age 59 1/2 on any distribution. PREMATURE DISTRIBUTIONS A 10% additional income tax may apply to any distribution received prior to age 59 1/2 unless such distribution falls within a specified exception contained in the Code or is rolled over into an IRA or other tax-qualified plan. The exception to the penalty tax include distributions made on account of death, disability, after separation from service after attainment of age 55, or as part of a series of substantially equal payments over the employee's life or life expectancy (or the joint lives or life expectancies of the employee and his or her beneficiary). EXCESS DISTRIBUTIONS A 15% excise tax may be imposed on aggregate annual distributions to be included in gross income from all qualified plans, IRA's and tax sheltered annuities that are in excess of a threshold amount. For installment and annuity distributions, the threshold amount if generally $150,000 (ultimately to be indexed for inflation). For distributions qualifying for lump sum distribution treatment and special averaging, the threshold amount is $750,000 (five times the general limit)-
6 APPLICATION FOR HARDSHIP WITHDRAWAL OF 401(K) CONTRIBUTIONS Employee SS# Location # Address City ST Zip Client Name The undersigned, a participant in the and Subsidiaries 401 (k) Plan, (the "Plan"), hereby request a distribution from my 401 (k) account. I have been made aware of the terms, conditions and penalties of taking this withdrawal. I represent that this withdrawal is necessary because of my immediate and heavy financial need occurring by reason of the following (check one and explain more fully in the space provided below): expenses for medical and/or dental care previously incurred by- myself, my spouse, or one of my dependents or necessary for one of these persons to obtain such medical or dental care. costs directly related to the purchase of a principal residence for myself (excluding mortgage payments) payment of tuition and related educational fees for the next 12 months of post-secondary education for myself, my spouse, or dependents. payments necessary to prevent the eviction of myself from my principal residence, or foreclosure on the mortgage of my principal residence. Explanation (exact details required): I represent that the amount necessary to satisfy my immediate financial need is $. Therefore, I request a taxable distribution from my account in the amount of $ further represent that this amount cannot be satisfied by simply discontinuing my contributions or by other unencumbered assets. Notary Public Signature of Participant Spouse Signature (MUST BE NOTARIZED) Plan Administrator Approval
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