EZ Enrollment Form

 
To enroll with more than one Investment Provider, please complete this form for each respective Provider.
  To enroll in the Deferred Compensation Plan:  
  Section 1- Enter personal identifying information.  
  Section 2- Select an Investment Provider, then select a percentage or amount to contribute from each paycheck.  
  Section 3- Designate one or more Primary Beneficiaries. If necessary select one or more Contingent Beneficiaries.  
  After completing Sections 1 through 3, click the “Confirm Enrollment Request” button to be directed to the submission page.  
  Contact the Bureau of Deferred Compensation at 877-299-8002 for assistance with this form.  
Section 1 - Personal Identifying Information
Gender:  
SSN: *      Date of Birth: MM/DD/YYYY      
Name (First MI Last):  
Enter name exactly as reported to payroll office
Mailing Address:  
City:       State:         Zip:    
  Email:    
Phone Numbers:   Primary:     Secondary:
  Dept/Agency:    
Pay Period:  
Approximate
Annual Salary: $
  * The disclosure of your social security number or taxpayer identification number is required. Section 112.215 F.S. authorizes the creation of the State of Florida Deferred Compensation Plan, which is intended to qualify for tax deferral pursuant to 26 USC 457. Use of the identifying numbers is mandated by 26 USC 6109. Your social security number or taxpayer identification number will be used as an identifying number for purposes of federal tax law.
Section 2 - Investment Provider and Contribution Percentage/Amount
STEP 1: Please Select an Investment Provider

Review the table below to select the Investment Provider that is right for you. Your contributions are automatically invested into the Target Date Fund at your selected Investment Provider. These Target Date funds are listed in order of five-year return below. If you do not want to contribute to the Target Date Fund, please contact your selected Investment Provider no earlier than 20 business days after submission of this form.

Target Date Funds are a mix of investments such as stocks, bonds, and cash equivalents that periodically re-adjust over time to grow more conservative as retirement age approaches. For additional information about Target Date Funds, and other available investments including mutual funds and investment products guaranteeing principal and interest, please refer to the Quarterly Performance Report or contact the Bureau of Deferred Compensation at 877-299-8002.
 

STEP 2: Step 2: Please select contribution amount: (If an approximate annual salary was entered in Section 1, percentage deferrals will calculate an approximate dollar amount.)
 
 
 
 
  %
$
All percentage calculations are estimated based on approximate annual salary, and the contribution may be higher or lower based on actual salary.
 % or $  per pay period.
 
Section 3 - Beneficiary Designation
In the event of my death, the balance of my account shall be paid to the Primary Beneficiary(s) who survive me using the specified percentages below. If no beneficiary survives me, the balance of my account shall be paid to my Estate. Primary Beneficiaries must total 100% and Contingent Beneficiaries must total 100%.
Primary Beneficiary
  Spouse? Date of Birth:   MM/DD/YYYY        
% of Account
Name (First MI Last):  
  Address:
City:     State:       Zip:  




A contingent beneficiary(s) may be selected to receive an account holder’s benefit if the primary beneficiary(s) predeceases the Participant.



  After confirming your request on the next screen, you will receive a copy of your submission by email. Please note we may need to contact you by phone or email in order to complete the processing of the request.
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