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Deferred Salary Agreement Template Form
Details on all of your Premiere Select SIMPLE
IRA Plan’s provisions.
Please retain a copy of this form for your records.
1 Employee Information
Name
–
Social Security Number
–
Street Address
City
State
–
Zip/Postal Code
Name of Employer (Company)
2 Salary Reduction Election
Subject to the requirements of the SIMPLE IRA Plan of the above-named employer, I authorize
$
(insert single-sum amount) (which equals
pay for each pay period and contributed to my SIMPLE IRA as a salary reduction...
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