Common use of Contribution Election Clause in Contracts

Contribution Election. If you have authorized your employer to withhold a percentage of your pay, convert that percentage to an approximate dollar amount. Total pre-tax employee contributions $ Employee Pre-Tax Salary Deferred Employer $ $ $ $ $ $ $ $ Total amount $ $ Total employer contributions $ Total or approximate contributions per pay period $ Employer Payroll Schedule: Weekly Monthly Twice per month Contributions will begin • I am eligible as an employee of either an educational organization (pursuant to Internal Revenue Code Section 170(b) (1)(A)(ii)) or a tax exempt organization (pursuant to Internal Revenue Code Section 501(c)(3)), to elect salary reductions under a 403(b) plan and consent to Thrivent acting as joint payment agent for annuities. • I request that my current employer or authorized representative of the employer remit my 403(b) contributions for purchase of an annuity contract as indicated above. • I have verified that the information on this form is correct and I have determined that the sum of all salary deferrals to all 403(b) plans, 401(k) plans, SIMPLE plans or SARSEP IRA plans I participate in are at or below IRS salary deferral limits for the current year. Neither Thrivent, Thrivent Investment Management Inc., nor the Custodian (if applicable) shall have the responsibility in this regard. This verification is not intended to be an employee self-certification. • I understand that employee 403(b) contributions are in lieu of the compensation payable directly to me. • I agree that if instructions on this agreement are inconsistent with the annuity application, this agreement will control. • I understand that this request shall supersede all prior agreements. Contributions will be allocated according to the contracts listed on this form for new business and/or existing annuities. • I understand that Thrivent must be an approved vendor with the employer sponsoring the plan in order to receive 403(b) contributions.