HTML Preview Investment Contract page number 1.
Individual Funds
Asset Allocation Funds
Name (First, Middle, Last) Birth Date (mm/dd/yyyy) Social Security Number
SECTION D - INVESTMENT OF FUTURE VESTED DEPOSITS (See reverse side for a description of the different Investment Funds.)
Check Only One
401(k) Plan or 457 Plan
Utah Retirement Systems
PO Box 1590
Salt Lake City, Utah 84110-1590
801-366-7720 or 800-688-4015
Fax 801-366-7445 or 800-753-7445
www.urs.org
INSTRUCTIONS:
1. Use this form to select how your existing Utah Retirement Systems (URS) 401(k) or 457 Plan is invested.
2. Review both sides of this form before completing.
3. Please type or print clearly in black ink.
4. If you fax this form, do not mail the original.
SECTION A - GENERAL INFORMATION
Mailing Address Daytime Phone Number
City State Zip Employer
SECTION B - PLAN SELECTION
SECTION C - FUTURE DEFERRALS FROM MY SALARY
Changes in deferrals to the 457 Plan cannot begin until the
calendar month following the date this form is signed.
SECTION E - TRANSFER CURRENT VESTED ACCOUNT BALANCE
SECTION F - SIGNATURE Date
DCCT-2 Rev 6/29/2011
No Change Use this section to change how your future deposits are invested. This may be changed daily and will not affect your current account.
Short Horizon Fund
___________%
Medium Horizon Fund
___________%
Long Horizon Fund
___________%
Income
Bond
Balanced
Large Cap Stock Value
Large Cap Stock Index
Large Cap Stock Growth
International
Small Cap Stock
IMPORTANT: The total of the percentage(s) in both columns combined must equal 100%. If the total does not equal 100%, the form will
be returned to you.
INVESTMENT CONTRACT
401(k) or 457 PLAN
Total amount to be withheld per pay period $ ____________ or ____________ % beginning the next possible pay period.
I am leaving employment and wish to have $ _____________ deferred from my final paycheck. Date of final paycheck _____________
Cancel future deferrals from my salary.
- -
Generally, Mark 100% In Only One Fund
Balanced
Small Cap Stock
International
Large Cap Stock Growth
Large Cap Stock Index
Large Cap Stock Value
___________%
___________%
Bond
Income
___________%
___________%
Long Horizon Fund
Medium Horizon Fund
___________%
___________%
Short Horizon Fund
Generally, Mark 100% In Only One Fund
Individual Funds
Asset Allocation Funds
No Change Transfers to current account balances can occur only every 30 days without incurring short-term trading fees. See reverse for details.
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
___________%
IMPORTANT: The total of the percentage(s) in both columns combined must equal 100%. If the total does not equal 100%, the form will
be returned to you.