Power of Attorney For Defined Contribution and Non-Qualified Plans

Transcription

1 Power of Attorney For Defined Contribution and Non-Qualified Plans To grant another person (agent), information only, limited or full authority to act on your Defined Contribution and Non-Qualified plan accounts. Review the following important information before choosing the extent of authority to grant to your agent(s). Note that granting Full Power of Attorney (Option C) empowers the agent(s) to act with the same authority you have on your accounts. Option A Option B Option C What your agent can do Info. only Limited agent Full agent 1. Obtain information on your accounts by phone. 2. Request statements and balance information. 3. Requesting a status on a distribution or outstanding check 4. Exchange of money between the funds in your plan. 5. Make contribution allocation changes 6. Exercise voting privileges with respect to Vanguard Funds 7. Inquire about beneficiary designations. 8. Initiate and process any type of distribution which you are eligible to take (withdrawals, loans, and terminations) 9. Process a loan payoff request 10. Request a Payroll Deduction Change 11. Change Dividend Elections 12. Request a reissue of a check/disbursement 13. Change your address Please do not alter, add, or cross out any of the above options. You must choose Option A, B, or C. Vanguard recommends you seek legal advice before completing this form. 1 of 5

2 Power of Attorney Use this form to grant another person (agent) full or limited authority to act on your accounts, or the authority to obtain information only. Questions? Call Print in capital letters and use black ink. 1. Participant/Beneficiary Information Provide your full, legal name. Name first, middle initial, last Last four digits of Social Security number Zip code Daytime phone area code, number, extension Evening phone area code, number, extension 2. Plan Information Plan Name(s) Plan Number(s) 3. Agent(s) List only the agent(s) who will have authority to act on your accounts. The authority of any agent who was previously authorized and is not listed below will be revoked. Name(s) of agent(s) new current of 5

3 4. Agent Information and Access If you are naming multiple agents, please copy section 4 and mail in with this Power of Attorney. If you are naming an organization as agent, the organization must complete and submit an Organization Resolution. If you are naming a trust as agent, the trustee(s) must complete and submit a Trustee Certification. Provide the full, legal name. Name of individual first, middle initial, last or trust or organization Birth date mm/dd/yyyy address optional If the agent has applied for an SSN or EIN but hasn t received it, enter the date on which the agent applied. Daytime phone area code, number, extension Evening phone area code, number, extension Social Security number (SSN) or employer ID number (EIN) Street address A P.O. box or rural route is not acceptable; address can be military APO or FPO. Street City, state, zip Country if not U.S. Review this section thoroughly before choosing the extent of account access you want to grant to the agent. You may not authorize your agent to have greater authority than you have under your plan(s). Check either Option A, Option B, or Option C (below). If you check more than one option, your agent will be authorized to serve at the lowest level of authority you have checked. Your agent(s) will have the authority you have chosen only over your accounts under the plan(s) identified in section 2. If you leave the boxes blank,your agent will be authorized to obtain information only. Option A. Information only Subject to Vanguard policies and procedures and the terms of my plan, I grant my agent(s) to have authority to perform the transactions on page 1 marked as information only authority by mail or phone, for my Vanguard Retirement Plan accounts. Option B. Limited agent authority Subject to Vanguard policies and procedures and the terms of my plan, I grant my agent(s) to have authority to perform the transactions on page 1 marked as limited agent authority by mail or phone, for my Vanguard Retirement Plan accounts. Option C. Full agent authority Subject to Vanguard policies and procedures and the terms of my plan, I grant my agent(s) to have authority to perform the transactions on page 1 marked as full agent authorization by mail or phone, for my Vanguard Retirement Plan accounts. 3 of 5

4 5. Authorization of Account Owner I agree that none of, Vanguard Fiduciary Trust Company, Vanguard Marketing Corporation, or the plan or plans identified in section 2 above and their directors, officers, employees, and agents (collectively, Vanguard) will be held responsible for my decisions or for the investment recommendations or decisions of my agent(s), and is under no duty whatsoever to question any instructions received from the agent(s) or the suitability of any transactions requested by him/her/them. I agree to indemnify and hold, Vanguard Fiduciary Trust Company, Vanguard Marketing Corporation, their affiliates, and each of the investment company members of The Vanguard Group and their respective officers, employees, agents (collectively, Vanguard), and the plans identified in section 2 harmless from acting on instructions, whether oral, written, or online, reasonably believed by Vanguard to have originated from my agent(s), and from all acts of my agent(s) involving the accounts covered by this authorization. Unless use of this Power of Attorney has been approved by the plan(s), I understand that this authorization and indemnity shall not take effect until it has been approved in writing by the administrator of the plan. If the plan(s) has approved use of this Power of Attorney, this authorization and indemnity shall be effective when received in good order by Vanguard. In the event of my disability or incapacity, this authorization will remain in full force and effect. This authorization will terminate only when one of the following occurs: Vanguard receives notice that my agent has resigned. I submit a new Power of Attorney with a later date than this Power of Attorney covering the same plan(s). Vanguard receives notice of my revocation. I understand that I have the right to revoke this authorization at any time and, if I have named multiple agents, any revocation will revoke the authority of all the agents. I further understand that each authorization covering the same accounts submitted to Vanguard will revoke any prior authorization in its entirety. Any revocation will not affect and liability resulting from transactions initiated before Vanguard has had a reasonable amount of time to act upon such notice. Vanguard receives notice of my death. I understand that the authority granted under this authorization terminates at my death. My death will not affect any liability resulting from transactions initiated before Vanguard has had a reasonable amount of time to act upon such notice. I have read this authorization in its entirety or had it explained to me, and I understand its contents. If you need more space for additional signatures, photocopy this page. Do not sign until you are in the presence of the person notarizing your signature below. Signature of Participant/Beneficiary Notarization/Affidavit of Account Owner The notary seal must be dated within 30 days of receipt of this document by Vanguard. On County or state of Signature of notary public Name of Owner or Authorized Person has appeared before me, has proven to be the individual named in Section 1, and has acknowledged that this authorization is his/her wish. Notary seal Commission expiration date mm/dd/yyyy 4 of 5

5 Mailing information Make a copy of your completed form for your records. Mail your completed form and any attached information in the enclosed postage-paid envelope. If you don t have a postage-paid envelope, mail to: For overnight delivery, mail to: Vanguard P.O. Box 1101 Valley Forge, PA Vanguard 400 Devon Park Drive Wayne, PA Plan Sponsor Approval, if required Signature of Authorized Signer/Plan Administrator 5 of 5