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09 401K Form - Mariscal Rocha, Maria

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48 views1 page

09 401K Form - Mariscal Rocha, Maria

Uploaded by

elena.69.mx
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Salary Deferral Agreement

NSC TECHNOLOGIES, LLC 401(K) PLAN


SALARY DEFERRAL AGREEMENT
Participant Information

Name ______________________________________________________________________________________________
Mariscal Rocha, Maria

Address ____________________________________________________________________________________________
grove street 1815 apt. 15 national city California 91950

Last 4 digits of Social Security Number ____________________________________________________________________


4536

Check one: X New Agreement Change

1. Plan provisions
You are permitted to defer a portion of your compensation to the Plan. The Plan allows you to designate the deferrals as either Pre-Tax
401(k) deferrals or Roth 401(k) deferrals (after-tax). In addition, the Plan limits the type of compensation that may be subject to the deferral
election (see the Summary Plan Description for details).

This agreement remains in effect until you revoke or modify it unless your salary deferrals are automatically suspended under the terms of
the Plan. Modifications to the agreement are permitted twice each year, prior to the first day of a Plan Year and the first day of the seventh
month of a Plan Year. You are also permitted to revoke your agreement at any time during the Plan Year.

The Plan permits you to defer your compensation up to the maximum amount allowed by law.

The law imposes a dollar limit on the amount you may defer in any calendar year. This amount may be adjusted annually to reflect cost of-
living increases announced by the IRS. Any questions regarding this election should be directed to the Administrator. The Plan also
permits you to make "catch-up" contributions if you are, or will be, at least age 50 during a calendar year. These are additional amounts
that you may defer, up to an annual limit imposed by law, regardless of any other limits imposed by the Plan.

2. Deferral election

This agreement is effective upon acceptance by the Administrator. However, deferrals will be made as soon as practicable following the
acceptance of this agreement by the Administrator. In accordance with the terms of the Plan and this agreement, I hereby authorize the
Employer to withhold from compensation (and treat as my deferrals) the following amount:

You may choose A, B or C:

A. ______% of my compensation (proportionately from each pay period).

B. $___________ per pay period OR per year (proportionately/flat amount from each pay period).

C. X Zero. I hereby elect: 1. X not to defer any of my compensation under the Plan. 2. to terminate my prior salary deferral
agreement.

If you are 55 years or older, and you selected option A or B above, you may choose to add option D:

D. I am 55 years of age and wish to add catch-up additional "Catch-Up Contributions" in the amount of: $___________
per pay period OR per year (proportionately from each pay period).

3. Type of deferral. The deferrals selected above will be:

Pre-Tax 401(k) deferrals

Roth 401(k) deferrals (after-tax)

4. Duty to review pay records.


I understand I have a duty to review my pay records (pay stub, direct deposit receipt, etc.) to confirm the Employer has properly
implemented my salary deferral election. Furthermore, I have a duty to inform the Administrator if I discover any discrepancy between my
pay records and this salary deferral agreement. I understand the Administrator will treat my failure to report any withholding errors for any
payroll to which my salary deferral agreement applies, by the cut-off date for the next following payroll, as my affirmative election to defer
the amount actually withheld (including zero). However, I thereafter may modify my deferral election prospectively, consistent with the Plan
terms.

5. Acknowledgement/Authorization:____________________________________________ Date of execution: _____________________


05/25/2021

Signature of Administrator: ___________________________________________________

Signature of Participant: _____________________________________________________


Electronically signed by Mariscal Rocha, Maria on 05/25/2021 at 2:57 pm EST at 177.236.68.10,
23.79.240.10

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