ࡱ> ;=:U !bjbjnn .*aa\\ "ooob"d"d"d"d"d"d"$#&f"mM"omm"9"m b"mb"V^!@""`٩w! N""0"!x&&""&"",oZ@ 4=0ooo"".ooo"mmmm&ooooooooo\B :  MONTANA UNIVERSITY SYSTEM TAX DEFERRED ANNUITY PROGRAM SECTION 403(b) SALARY REDUCTION AGREEMENT ( ) This is a New Salary Reduction Agreement ( )This is a Change to an Existing Salary Reduction Agreement BY THIS AGREEMENT, made between (Employee Name-print)_________________________________________ (Home Address & Phone Number)__________________________________________________________________ (ID number)__________________________ and 51, we agree as follows: As soon as possible after the date the Employee submits this form, the Employees salary will be reduced by the amount below. This Agreement is legally binding and irrevocable for both the Institution and the Employee with respect to amounts earned while the Agreement is in effect. However, either party may terminate this agreement as of the end of any month by giving at least thirty days written notice. The Agreement will not apply to salary earned after the Agreement is terminated. Effective Date for first salary reduction ___________________________. The amount of the salary reduction* shall be deducted pre-tax from gross salary in monthly/bi-weekly installments as you specify below. These monthly/bi-weekly elections will produce a total annual contribution that does not exceed the Employees statutory limitation under IRC Section 415, or IRC Section 402 (g) whichever is the least. For employees age 50 and older, this amount will include any additional catch-up contributions permitted under IRC 414 (v). The annual amount designated below, shall be transmitted by the Employer in accordance with the 403 (b) program established and maintained by the Employer, such that equal monthly amounts or the monthly amounts shown below shall be paid into contracts issued by Montana University System approved investment providers. Employees may choose any two among the following approved providers (circle your choice(s) and note the name of the vendor(s) along with the elected amount below): Voya, MetLife, TIAA, and VALIC. Academic year or 10 month employees will automatically have an annuity deduction taken from any summer paychecks issued. If you anticipate working in the summer and want deductions taken, do nothing. If you do not want deductions taken out of your summer checks, enter zero in these months. If you want to decrease or increase the amount of the deduction for those summer checks, enter the amount in $ or % in the spaces below. Month Amount % Provider Month Amount % Provider Jan $________ _____% ______________ Jul $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ Feb $________ _____% ______________ Aug $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ Mar $________ _____% ______________ Sept $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ Apr $________ _____% ______________ Oct $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ May $________ _____% ______________ Nov $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ Jun $________ _____% ______________ Dec $________ _____% ______________ $________ _____% ______________ $________ _____% ______________ (over) Total Annual Election $_____________ **This agreement has been executed by and on behalf of the parties hereto on this _____day of ____________, 2____ ____________________________________ Employer 51 of The University of Montana (Employee Signature) By: _____________________________ ** By signing this agreement both parties Title: agree to all the information listed on the front and back of this form. If the Employee terminates employment with the Employer, this amendment shall automatically terminate according to the terms of the employment contract. If the Employer terminates the 403 (b) program, this amendment shall automatically terminate. The Employee agrees that the Employer shall have no liability whatsoever for any loss suffered by the Employee with regard to his or her selection of an investment provider contract or of mutual fund shares, or by reason of the Employers transmittal of contributions, providing they are transmitted in accordance with the 403 (b) program. The Employee understands that: the purpose of the Employer in executing this agreement is to provide the Employee with an opportunity to benefit from the provisions of Section 403 (b) the Employer does not recommend to the Employee that he or she participate in the 403 (b) program, the Employer does not warrant any particular tax consequences to the Employee, all computations in connection with the determination of the amount of the salary reduction hereby authorized, including the amount of the exclusion allowance, includable compensation and years of service pursuant to such Section of 403 (b) shall be the responsibility of the Employee. * The amount should be reviewed with Benefit Services before the execution of this agreement. bux = Y  u&,Wxy()*,.kro!!!$jh5CJU\mHnHu hZ<>*CJh5CJ\h 5CJ\ hZ<CJhZ<5CJ\)8bc= &5*+ $a$ !  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