SHEET METAL WORKERS LOCAL #3 401(K) PLAN
VOLUNTARY DEFERRAL CHANGE FORM
Name _________________________________ Social Security # ___________________________
Address _________________________________ Current Contractor __________________________
________________________________________ Phone # ___________________________________
________________________________________ Date of Birth _______________________________
Your total 401(k) contribution is as follows: Automatic deferral + Voluntary deferral = Total 401(k) contribution.
Automatic deferral per hour is determined by your experience as follows:
*pre-apprentice or semester 1-4 apprentice $0.00/Hr
*semester 5 apprentice or more experience $0.60/Hr (Sioux City) $1.00/Hr (Lincoln)) $1.65/Hr (Omaha)
These changes will be calculated off the most recent signed deferral form Benefit Plans has on file for your deferral.
Complete one option (must be in $0.10 increments)
Raise my current voluntary deferral by $___________ per hour OR
Lower my current voluntary deferral by $___________ per hour OR
Change my current voluntary deferral to $___________ per hour
Change my current voluntary deferral to $________ per paycheck
Section III. Signature: _________________________________________ Date ________________
Please return to:
Benefit Plans, Inc. 16924 Frances Street, Suite 100, Omaha NE 68130
OR Fax to 402-891-0444 Attn: Martha Dean
OR Email to firstname.lastname@example.org
*Do not submit investment election changes with this form. Benefit Plans Inc. is not authorized to process transfer requests.
Investment questions can be directed to Mark Slattery or Shannon Case at (402) 502-5700.