SHEET METAL WORKERS LOCAL #3 401(K) PLAN

VOLUNTARY DEFERRAL CHANGE FORM

 

Section I. General Information  (Please complete all information)

 

Name    _________________________________                            Social Security # ___________________________

 

Address _________________________________                            Current Contractor __________________________

                                                                                                                                                                          (Required Field)

________________________________________                           Phone # ___________________________________

 

________________________________________                           Date of Birth _______________________________

 

Section II. Contribution Changes

 

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)

 

PLEASE READ THROUGH YOUR ELECTION CAREFULLY

These changes will be calculated off the most recent signed deferral form Benefit Plans has on file for your deferral.

 

*Omaha/Lincoln Members:Text Box: Office Use Only
 
Prior Def  $________
 
 
Change ___________
 
New
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    

 

 

**Southwark Members:

 

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 marthad@bpiomaha.com

 

*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.