|
Last Name:
First Name:
Middle Initial:
|
|
Social Security Number: |
- -
|
|
Name of current employer:
|
|
|
Date of Birth:
|
|
|
2008 Anticipated Salary: |
.00
|
|
Years employed with present employer :
|
|
|
What is the first name of the company where the salary reduction results associated with this calculation will be sent?
|
|
|
What is the total of all contributions made to retirement plans while working with your present employer thru 12/31/2007?
|
.00
|
|
What is the total cumulative amount contributed in excess of the
applicable 402(g) limits for all years with this employer?
|
.00
|
|
Applicable limits:
$15,500 for 2007; $15,000 for 2006; $14,000 for 2005;
$13,000 for 2004; $12,000 for 2003; $11,000 for 2002;
$10,500 for 2001
& 2000; $10,000 for 1999 & 1998; $9,500 prior to 1998
|
|
Check here if your employer offers a 401(k) plan :
|
|
|
If you participate in the 401(k) plan, please list your estimated annual contribution:
|
.00
|
|
Please input the Representative’s Name completing this form:
|
|
|
Please input the Representative’s phone number:
|
|