Enrolling: the choice is yours

Transcription

1 To complee his form, read he aached insrucions. Reurn he compleed form o your plan adminisraor. COMPANY NAME Need help? ABC Company Talk wih your personal enrollmen specialis a CONTRACT NUMBER JHENROLL ( ) PERSONAL INFORMATION Provide us informaion abou you Las Name Firs Name, Iniial P L E A S E P R I N T P L E A S E P R I N T Social Securiy Number Dae of birh (mmm/dd/yyyy) X X X X X X X X X mmm / dd / yyyy CONTRIBUTIONS Selec your conribuion amoun PRE-TAX CONTRIBUTIONS I elec o conribue he following percenage or amoun per pay period on a pre-ax basis + : (Selec one box only) 15% 12% 9% 6% 3% OR Oher: % or $ YES! I wan hese conribuions o increase by 2% or $40 each year unil a maximum of 15% or $3,000 is reached ROTH 401(K) AFTER TAX CONTRIBUTIONS I elec o conribue he following percenage or amoun per pay period on a pos-ax basis + : (Selec one box only) 15% 12% 9% 6% 3% OR Oher: % or $ + Subjec o he plan s conribuion limi and IRS limis. INVESTMENT OPTIONS Selec your invesmen opions. Choose eiher 1. EZCHOICE OR 2. YOUR CHOICE 1. EZCHOICE: Check ONE box only in his secion. 100% of your conribuions will be placed in his porfolio. JH Lifesyle JH Lifesyle JH Managed Russell Acive Managed Volailiy LifePoins Targe Dae Porfolios (Lifecycle) Lifesyle Porfolios Sraegies Porfolios Porfolios Sraegy Funds JH To Managed Porfolio RC 100% Conservaive CLS 100% CLM 100% CLV 100% CRS 100% JH Through Managed Porfolio RA 100% Moderae MLS 100% MLM 100% MLV 100% MRS 100% JH Through Acive Sraegies RL 100% Balanced BLS 100% BLM 100% BLV 100% BRS 100% T. Rowe Price Reiremen Funds TR 100% Growh GLS 100% GLM 100% GLV 100% GRS 100% American Cenury One Choice AM 100% Aggressive ALS 100% ALM 100% ALV 100% ARS 100% If you seleced EZCHOICE, go direcly o page 8 o review he Moving Forward informaion and sign he form. Your company s plan offers invesmen opions hrough is group annuiy conrac wih John Hancock Life Insurance Company (U.S.A.) GT-P GE 11/ XX/XX/20XX X00 Page 1 of 8 GAXXXXXXXXXX Enrolling: he choice is yours Congraulaions! By deciding o paricipae in PC SPECIALISTS, INC.'s qualified reiremen plan, you are aking conrol of your financial fuure. From he day you join, your reiremen plan sars working o help you build your reiremen savings. BEFORE you begin You will need your Conrac number: and your Enrollmen access number: I s quick and easy! Online Go o On he phone Call us a JHENROLL ( ) Talk o an enrollmen represenaive o enroll on he phone. They can also answer quesions you may have around he process of joining your company s plan, moving oher reiremen plans ino your new plan and much more. We are available from 8 a.m. o 8 p.m. (EST), Monday o Friday. Your Enrollmen Form Tear ou, complee and reurn o your plan adminisraor. Page 1 of 8 Use he enrollmen form Carefully fill in all he required informaion including your personal deails, conribuion amoun and invesmen opions. Remember o sign and dae he las page of he form and reurn all pages o your plan adminisraor. GT-P EFORM-GE 11/ jheform.com Or scan his QR Code wih your smarphone Wach how easy i is o enroll wih John Hancock, go o jhenrollmen.com

2 Things you need o know Abou choosing a conribuion amoun There are TWO ways you can conribue o your qualified reiremen accoun: Qsf.uby; your conribuions are no axed unil you reire and may be in a lower ax bracke. Bgufs.uby )Spui*; your conribuions are axed now. Conribuions, including salary deferral conribuions, salary deferral reaed as cach-up conribuions, and any plan ransfers from eiher your curren employer or a previous qualified plan (as accepable by your curren plan), will be invesed in he same manner unless oherwise direced by eiher you on our websie or your company. Excepions may include: 1) Employer conribuions (if applicable) direced by your employer and/or, 2) Rollover conribuions as direced by you via a Roll-in form. Abou choosing your invesmen opions There are TWO ways o choose how your conribuions will be allocaed: 1) EZChoice: Wih one decision, allocae all of your conribuions o one professionally managed and diversified asse allocaion porfolio. Choose one of he following: a) Targe Dae Porfolio based on a arge dae ha is closes o he year ha you aain age 67. b) Lifesyle Porfolio based on your risk olerance. On he form, hey are lised in order of lower (blue) o higher (red) risk. PS 2) Your Choice: Research and selec your invesmen opions from all of he Funds available under your company's qualified reiremen plan as lised on he following pages. For more informaion on hese Funds, see he Invesmen Opions (Fund Shees) secion of our websie or from your plan adminisraor. Ener he percenage you wan o inves beside he corresponding Fund. If you selec Your Choice, remember ha you mus provide whole percenages only and he oal sum of all percenages mus equal 100%. Noe: 1. If your allocaion insrucions under Your Choice are no legible or do no equal 100%, John Hancock will prorae he allocaion insrucions you have provided o equal 100%. In he even ha John Hancock canno prorae your insrucions, your conribuions will be allocaed o he defaul invesmen opion designaed by your plan rusee. 2. If muliple boxes have been checked in he EZChoice secion, if boh EZChoice and YOUR CHOICE secions have been filled ou, if John Hancock receives your conribuions before i receives your invesmen insrucions and/or you do no provide a signaure on your enrollmen form, all your conribuions will be invesed ino he defaul invesmen opion designaed by your plan rusee, provided John Hancock has your firs and las name and Social Securiy Number. 3. If you have seleced a Targe Dae Porfolio in he EZChoice secion and have no provided a Dae of Birh, hen all of your conribuions will be invesed, and will remain invesed, in he 2010 porfolio in he seleced suie of Targe Dae Porfolios unil new insrucions are provided. Abou he moving forward secion Consolidae your reiremen savings If you have any quesions Your plan adminisraor can help you wih any quesions you may have abou your company s qualified reiremen plan, your eligibiliy for he plan, naming a beneficiary, his form or if you require anoher form. More informaion is also available a Consolidae all your qualified reiremen accouns (401(k), 457(b) *, 403(b), IRA, ec) ino your new qualified reiremen accoun^. To do his, simply indicae ha you would like help consolidaing your accouns on he enrollmen form or call us a * Only governmenal 457(b) accouns can be consolidaed ino qualified reiremen accouns. ^Speak wih a Financial Represenaive o deermine if combining your reiremen accouns is suiable for you, as oher opions are available.

3 Your Enrollmen Form To complee his form, read he aached insrucions. Reurn he compleed form o your plan adminisraor. DPNQBOZ OBNF PC SPECIALISTS, INC. DPOUSBDU OVNCFS Need help? Talk wih your personal enrollmen specialis a JHENROLL ( ) PERSONAL INFORMATION Provide us informaion abou you Las Name Firs Name, Iniial PLEASE PRINT PLEASE PRINT Social Securiy Number Dae of birh (mmm/dd/yyyy) XXX XX XXXX mmm / dd / yyyy CONTRIBUTIONS Selec your conribuion amoun PRE-TAX CONTRIBUTIONS J fmfdu up dpousjcvuf uif gpmmpxjoh qfsdfoubhf ps bnpvou qfs qbz qfsjpe po b qsf.uby cbj, ; )Tfmfdu pof cpy pomz* 15% 12% 9% 6% 3% OR Oher: % or $ ROTH 401(K) AFTER TAX CONTRIBUTIONS J fmfdu up dpousjcvuf uif gpmmpxjoh qfsdfoubhf ps bnpvou qfs qbz qfsjpe po b qpu.uby cbj, ; )Tfmfdu pof cpy pomz* 15% 12% 9% 6% 3% OR Oher: % or $ + Subjec o he plan's conribuion limi and IRS limis. INVESTMENT OPTIONS Selec your invesmen opions. Choose eiher 1. EZCHOICE OR 2. YOUR CHOICE 1. EZCHOICE: Check ONE box only in his secion. 100% of your conribuions will be placed in his porfolio. Tear ou, complee and reurn o your plan adminisraor. Page 1 of 5 Targe Dae Porfolios Lifesyle Porfolios JH Lifesyle Acive Sraegies BlackRock LifePah Index Funds BR 100% Conservaive Moderae Balanced Growh Aggressive CLS 100% MLS 100% BLS 100% GLS 100% ALS 100% If you seleced EZCHOICE, go direcly o page 5 o review he Moving Forward informaion and sign he form. Your company's plan offers invesmen opions hrough is group annuiy conrac wih John Hancock Life Insurance Company (U.S.A.) HU.Q Page 1 of 5 12/05/ E01 GIFLS-3a GA

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5 Enrollmen Form coninued Social Securiy Number X X X X X X X X X Conrac Number: INVESTMENT OPTIONS coninued Sfnjoefs; ljq up qbhf 6 jg zpv fmfdufe F[Dipjdf/ 2. YOUR CHOICE: Ener a percenage for each invesmen opion ino which your conribuions will be placed. A selecion of deailed Fund shees is available on our websie, along wih Reurns and Fees informaion for he mos recen monh-end. These conain imporan informaion for each invesmen opion available under he group annuiy conrac, including deails on he underlying muual funds, invesmen objecives, level of risk, underlying allocaions and charges, as well as oher imporan informaion abou he invesmen opions which should be carefully considered. Please read his informaion carefully prior o choosing your invesmen opions. n You can choose professionally consruced and mixed porfolios, creae your own mix, or a combinaion of boh. n Each invesmen opion you can choose from is color-coded o show he level of risk and poenial reurn. Each color represens a differen level of risk versus poenial reurn, ranging from conservaive (blue) o aggressive (red). n The oal sum of all percenages mus equal 100%. Noe: Allocaing asses o only one or a small number of he invesmen opions (oher han professionally consruced and mixed Porfolios) should no be considered a balanced invesmen program. In paricular, allocaing asses o a small number of opions concenraed in paricular business or marke secors will subjec your accoun o increased risk and volailiy. Examples of business or marke secors where his risk may be paricularly high include: a) echnology-relaed businesses, including Inerne relaed businesses, b) small cap securiies and c) foreign securiies. We do no provide advice regarding appropriae invesmen opion allocaions. Conac your financial represenaive for more deails. Oher han he Guaraneed Ineres Accouns, uni values depend on marke performance and are NOT guaraneed. Asse Allocaion Porfolios Targe Dae Porfolios CODE % BlackRock LifePah Index Funds managed by BlackRock Invesmen Managemen, LLC BlackRock LifePah Index 2055 Fund BlackRock LifePah Index 2050 Fund BlackRock LifePah Index 2045 Fund BlackRock LifePah Index 2040 Fund BlackRock LifePah Index 2035 Fund BlackRock LifePah Index 2030 Fund BlackRock LifePah Index 2025 Fund BlackRock LifePah Index 2020 Fund BlackRock LifePah Index Reiremen Fund Individual Invesmen Opions BRJ BRI BRH BRG BRF BRE BRD BRC BRA Conservaive CODE % Money Marke Fund sub-advised by John Hancock Asse Managemen Vanguard Shor-Term Federal Fund sub-advised by Vanguard Group, Inc. 5-Year Guaraneed Ineres Accoun 10-Year Guaraneed Ineres Accoun MMR GOV 5YC 10YC Income CODE % DFA Inflaion-Proeced Securiies Fund sub-advised by Dimensional Fund Advisors, Inc. (DFA) Fideliy Advisor Toal Bond Fund sub-advised by Fideliy Managemen & Research Company (Fideliy) High Yield Fund sub-advised by Wesern Asse Managemen Co. (WAMCO) T. Rowe Price Specrum Income Fund sub-advised by T. Rowe Price Associaes, Inc. INP FBF HYF INC Lifesyle Porfolios CODE % Acive Sraegies sub-advised by John Hancock Asse Mgm JH Lifesyle Aggressive - Acive Sraegies JH Lifesyle Growh - Acive Sraegies JH Lifesyle Balanced - Acive Sraegies JH Lifesyle Moderae - Acive Sraegies JH Lifesyle Conservaive - Acive Sraegies ALS GLS BLS MLS CLS Growh & Income CODE % American Balanced Fund sub-advised by American Funds Group Uiliies Fund sub-advised by MFS Invesmen Managemen ABF ULT Growh CODE % 500 Index Fund sub-advised by John Hancock Asse Managemen Blue Chip Growh Fund sub-advised by T. Rowe Price Associaes, Inc. Franklin Muual Global Discovery Fund sub-advised by Franklin Templeon Mid Cap Index Fund sub-advised by John Hancock Asse Managemen Oppenheimer Global Fund sub-advised by OppenheimerFunds, Inc. Oppenheimer Inernaional Growh Fund subadvised by OppenheimerFunds, Inc. IND BCF DIS MCI WWF OIG Turn he page for more invesmen opions... Tear ou, complee and reurn o your plan adminisraor. Page 2 of 5 HU.Q Page 2 of 5 12/05/ E01 GA

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7 Enrollmen Form coninued Social Securiy Number X X X X X X X X X Conrac Number: Growh CODE % Toal Sock Marke Index Fund sub-advised by John Hancock Asse Managemen Vanguard Mid-Cap Value ETF sub-advised by Vanguard Group, Inc. Washingon Muual Invesors Fund sub-advised by American Funds Group TSM VOE WMI Aggressive Growh CODE % DFA US Small Cap Fund sub-advised by Dimensional Fund Advisors, Inc. (DFA) Franklin Small-Mid Cap Growh Fund sub-advised by Franklin Templeon Inernaional Equiy Index Fund sub-advised by SSgA Funds Managemen, Inc. Inernaional Small Cap Fund sub-advised by Franklin Templeon Invesco Small Cap Growh Fund sub-advised by Invesco Advisers, Inc. PIMCO Commodiy Real Reurn Sraegy Fund subadvised by Pacific Invesmen Managemen Company Real Esae Securiies Fund sub-advised by Deusche Asse Managemen, Inc. Royce Opporuniy Fund sub-advised by Royce & Associaes, LLC SCP SCG IIF ISF SCO CRR REF OPP Aggressive Growh CODE % T. Rowe Price Healh Sciences Fund sub-advised by T. Rowe Price Associaes, Inc. T. Rowe Price Science & Technology Fund subadvised by T. Rowe Price Associaes, Inc. Vanguard Energy Fund sub-advised by Vanguard Group, Inc. HLS SCT VEN Personal Brokerage Accoun Provided by U.S. Bank, N.A. Allocaed o PBA % A personal brokerage accoun (PBA) les you direc and manage your conribuions a your discreion. Asses in he PBA are held separaely by U.S. Bank, no John Hancock USA. Your PBA is no a separae accoun and is no a guaraneed accoun under he group annuiy conrac. Unil your PBA is esablished wih U.S. Bank, conribuions made on your behalf will remain in he cash accoun under he group annuiy conrac and be credied wih Funds on Deposi ineres. Turn he page for more invesmen opions... Tear ou, complee and reurn o your plan adminisraor. Page 3 of 5 HU.Q Page 3 of 5 12/05/ E01 GA

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9 Enrollmen Form coninued Social Securiy Number X X X X X X X X X Conrac Number: Guaraneed Income for Life Selec You should review he Guaraneed Income for Life Selec informaion before selecing his opion and ensure you include he following informaion on his form: your dae of birh in he Personal Informaion secion your gender here: Female Male Guaraneed Income Feaure CODE % Selec Asse Allocaion Growh Porfolio sub-advised by John Hancock Asse Managemen Selec Asse Allocaion Balanced Porfolio subadvised by John Hancock Asse Managemen Selec Asse Allocaion Moderae Porfolio subadvised by John Hancock Asse Managemen Selec Asse Allocaion Conservaive Porfolio subadvised by John Hancock Asse Managemen Your Choice TOTAL SAG SAB SAM SAC 100% Before elecing Guaraneed Income for Life Selec, carefully review he Guaraneed Income for Life Selec informaion provided which describes he erms, benefis, condiions, and resricions applicable o his feaure. In addiion, he informaion describes he annual fee of 0.75% for his feaure which is in addiion o he Expense Raio for he Guaraneed Income for Life Selec Funds. This fee is calculaed based on he Benefi Base, and deduced monhly from he marke value of your invesmens in such Funds. The Guaraneed Income for Life Selec feaure will no be acivaed unless you provide us wih your Dae of Birh, Gender and Signaure on his form. In he even ha no all informaion is provided, John Hancock will allocae your conribuions, in one of he following wo ways, unil such ime ha he required informaion is provided o John Hancock and a new elecion form is compleed and reurned o John Hancock: 1) If 100% of your invesmen insrucions were direced o Guaraneed Income for Life Selec Fund(s), all conribuions will be invesed ino he conracs Defaul Invesmen Opion, or 2) if invesmen insrucions were only parially direced o Guaraneed Income for Life Selec Fund(s), your insrucions will be pro-raed across he oher funds seleced. IMPORTANT The oal of all your fund selecions in he Your Choice secion MUST EQUAL 100% Tear ou, complee and reurn o your plan adminisraor. Page 4 of 5 HU.Q Page 4 of 5 12/05/ E01 GA

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11 Enrollmen Form coninued Social Securiy Number X X X X X X X X X Conrac Number: MOVING FORWARD Taking advanage of oher benefis CONSOLIDATE MY ACCOUNTS YES! I would like help in consolidaing my reiremen accouns. * Conac me a ( ) - and ( address ** ) o discuss my opions. The bes ime o call is around A.M/P.M. EST (or, call us direcly a ). * Available for plans uilizing John Hancock s consolidaion services; rollovers are subjec o he provisions of your company s plan. ** addresses will only be used for consolidaion services. SIGNATURE I elec no o conribue a his ime. Noe: Conac your plan adminisraor o deermine he nex plan enry dae. I acknowledge ha if I have seleced he I elec no o conribue box on his form, I will no be making any conribuions o he plan. I acknowledge ha if I have provided my Gender and if I have seleced he Guaraneed Income for Life Selec Fund code(s) in he Your Choice secion, I am elecing Guaraneed Income for Life Selec and ha I have read and undersand he informaion provided on and wih his form relaing o he feaure. I also agree o he erms, condiions, resricions and fees applicable o Guaraneed Income for Life Selec and furher agree ha he benefis provided by his feaure are subjec o he erms and condiions of he reiremen plan of which I am a paricipan. I acknowledge ha his plan offers invesmen opions hrough my company's group annuiy conrac wih John Hancock and ha I have read and undersand he insrucions ha accompany his form including informaion on EZChoice, Your Choice and he erms, condiions, resricions, fees and risk ha relae o hem and oher pars of he insrucions. If I have seleced a Targe Dae Porfolio in he EZChoice secion, I undersand ha my porfolio will be based on my provided age and wih a arge reiremen dae ha is closes o he year ha I aain age 67. X mmm / dd / yyyy Signaure of Paricipan Prin Name Dae Tear ou, complee and reurn o your plan adminisraor. Page 5 of 5 John Hancock Life Insurance Company (U.S.A.) (John Hancock USA) is referred o as "John Hancock". Group annuiy conracs and recordkeeping agreemens are issued by: John Hancock Life Insurance Company (U.S.A.), Boson, MA (no licensed in New York). The Invesmen Managemen Services Division of John Hancock provides invesmen informaion relaing o he group annuiy conrac. No insured by he Federal Deposi Insurance Corporaion (FDIC) MAY LOSE VALUE NOT BANK GUARANTEED NOT INSURED BY ANY GOVERNMENT AGENCY 2016 All righs reserved. Make sure you sign above, hen reurn form and any oher iems o your plan adminisraor. HU.Q Page 5 of 5 12/05/ E01 GA

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13 Beneficiary Designaion Form Beneficiary designaion informaion below is solely for he benefi of he plan adminisraor of PC SPECIALISTS, INC.. This informaion shall no be mainained or aced upon by John Hancock USA. Repor any change o his informaion direcly o he plan adminisraor a your company. Noe: Your plan may be subjec o he join and survivor annuiy requiremen. If i is, check wih your plan adminisraor, as a differen beneficiary form may be required. Your plan adminisraor can ell you if his requiremen applies o your plan. For oher plans, you mus elec your spouse as sole Primary Beneficiary, unless he/she consens in wriing o your naming anoher Primary Beneficiary. CONTRACT NUMBER SOCIAL SECURITY NUMBER X X X X X X X X X Name (Las Name, Firs Name, Iniial) PLEASE PRINT MARRIED paricipan I undersand ha I mus elec my spouse as sole Primary Beneficiary under his plan unless he/she consens in wriing o my naming anoher Primary Beneficiary. (See your plan adminisraor for a Spousal Consen Form if naming a Primary Beneficiary oher han your spouse.) UNMARRIED paricipan I undersand ha he following designaion becomes null and void in he even of my marriage. I will promply inform my plan adminisraor of any change in my marial saus. BENEFICIARY DESIGNATION PRIMARY BENEFICIARY Name (Las Name, Firs Name, Iniial) PLEASE PRINT Telephone number Social securiy number Dae of birh Relaionship o paricipan % Share XXX XX XXXX mmm / dd / yyyy Address Ciy Sae Zip code CONTINGENT BENEFICIARY Name (Las Name, Firs Name, Iniial) PLEASE PRINT Telephone number Tear ou and reurn o your plan adminisraor. Page 1 of 1 Social securiy number Dae of birh Relaionship o paricipan % Share XXX XX XXXX mmm / dd / yyyy Address Ciy Sae Zip code Exra Page for Addiional Beneficiaries Aached. If you require addiional space o include more primary and/ or coningen beneficiaries, please aach a separae page providing all he above designaion informaion and he percenage of each beneficiary. Noe: Percenage shares mus equal 100% for boh primary and coningen beneficiaries. SIGNATURE I hereby designae he above individual(s) as my beneficiary(ies) o receive he benefi payable (if any) under his plan in respec of my deah. I undersand ha if I oulive my primary beneficiary(ies), benefis will be paid o my esae on my deah unless I designae a coningen beneficiary(ies). X Signaure of Paricipan Dae mmm / dd / yyyy HU.Q Reurn o your plan adminisraor. Do NOT reurn o John Hancock. GA

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