Employee Retirement Plan

EMPLOYEE RETIREMENT PLAN

Plan Identification

Plan Name:

Plan Effective Date:    Plan Year End:

Employer / Plan Sponsor

Contact Phone:    Contact Email:

Plan Type and Funding

Select applicable plan type(s):
401(k) elective deferral plan Profit sharing (employer discretionary contributions) Defined benefit pension SIMPLE retirement plan

Participant Personal Information

Phone:    Email:

Position and Employment Information

Reporting Manager:    Start Date:    Salary/Rate:

Employment History (Most Recent Two Employers)

Title:    Dates Employed:

Title:    Dates Employed:

Education

Graduation Date:

References (Professional)

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Phone:    Email:    Relationship:

Contributions & Elections

Employee Elective Deferral Election (if applicable): Employee elects to contribute of eligible compensation per payroll period.

Employer Matching Formula (if applicable):

Vesting Schedule

Select the applicable vesting schedule (check one):
3-Year Cliff (100% after 3 years service)
Graded Vesting over 6 years (20% after 2 years, then 20% increments)
Custom schedule (describe below)

Distributions, Loans, Hardship Withdrawals

Distribution events permitted: termination of employment, retirement, disability, death, hardship as defined by the plan document. Loans to participants are permitted subject to plan terms including maximum outstanding loan amounts, repayment schedules and security. The plan sponsor retains the right to establish procedural rules governing loans and withdrawals consistent with the plan document.

Amendment, Termination and Plan Administration

The Employer reserves the right to amend, modify or terminate the Plan in whole or in part at any time, provided that no amendment shall deprive a participant of accrued benefits except as permitted by law. Upon termination, plan assets will be distributed in accordance with plan provisions and applicable fiduciary standards.

Plan Administrator/Trustee:    Administrator Address:

Fiduciary Duties and Indemnification

The Plan Administrator and any Trustees appointed hereunder shall act as fiduciaries in the administration and investment of plan assets and shall discharge their duties with care, skill, prudence and diligence. The Employer shall have the authority to appoint or remove Trustees and Administrators. The Plan document requires that fiduciaries avoid conflicts of interest and act solely in the best interests of participants and beneficiaries. Fiduciaries are entitled to indemnification to the fullest extent permitted by law for actions taken in good faith and within the scope of their authority.

Legal Disclosures

At-Will Employment: Participation in this Plan is separate from employment status. Nothing in this Plan or participation in the Plan shall be construed as an employment contract or a guarantee of continued employment. Employment remains at-will and may be terminated by either the Employer or the Employee at any time, with or without cause, except where prohibited by law.

Equal Opportunity: The Employer administers this Plan in a manner consistent with equal employment opportunity obligations and nondiscrimination rules. Eligibility and benefits shall be determined in accordance with the terms of the Plan without regard to race, color, religion, sex, age, national origin, disability, or other protected characteristics, except as permitted by law.

Authorizations, Certifications and Acknowledgements

Authorization to Verify: The Participant authorizes the Employer and its agents to verify all information provided in this enrollment and to contact previous employers, references and other sources as reasonably necessary to administer the Plan and determine eligibility.

Background Checks: Where permitted by law and applicable plan rules, the Participant consents to such background checks as are reasonably required by the Employer for administration of Plan benefits and compliance with fiduciary and legal obligations.

Participant Certification: I certify that all information provided on this form is true, accurate and complete to the best of my knowledge. I understand that providing false or misleading information may subject me to disciplinary action, up to and including termination, and may jeopardize my participation in the Plan. I understand that my participation, elections and beneficiary designations will be governed by the Plan document and trust agreement.

Participant Printed Name:

Participant Signature:    Date:

Records and Notices

The Employer will maintain plan records and participant files as required by law. Notices required under the Plan will be delivered in writing to the address on file for the participant or to the electronic address on file if the participant has provided consent to electronic delivery.

Sign Now