Salary Reduction Employment Agreement For AAL Variable Annuity
A. Employee's Request for Salary Reduction
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1. Employee name Employee Social Security no.
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Employer name Employer telephone number AAL billing account no, if known
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Employer mailing address City State ZIP Code
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I request that my current employment terms be modified to substitute the
purchase of a variable annuity contract as directed herein, in lieu of the
compensation otherwise payable directly to me. If accepted by my employer, this
request will constitute an agreement which shall supersede and replace all prior
agreements or requests which I have made. For such purpose, I hereby authorize
you to:
2. Reduce my cash compensation 3.__ New variable __ Change to existing variable
for each pay period by: annuity certificate annuity certificate
$__________________ or ___________% Check all boxes that apply.
__ Add Fixed Annuity(ies)* __ Delete Fixed Annuity(ies)
__ Add Mutual Fund(s)* __ Delete Mutual Fund(s)
The salary reduction will begin: __ Other - Describe in detail:
The pay period under this agreement is: ________________________________________
__Weekly __Bi-weekly __Monthly __Twice per month Please complete form 5245 "Salary Reduction Employment
__Less than 12 months - List months no payment will be made: Agreement"
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4. Apply the salary reduction X Account Employee Salary Reduction Contribution
amount for each pay period
specified above to the purchase of
an AAL Variable Annuity.
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New certificate $ or %
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Existing certificate No: $ or %
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Large Company Stock $ or %
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Small Company Stock $ or %
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International Stock $ or %
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High Yield Bond $ or %
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Bond $ or %
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Balanced $ or %
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Money Market $ or %
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Fixed Account $ or %
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Total Contributions $ or 100%
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If you choose more than one account for purchase from your salary reduction
amount, please indicate the dollar amount or the percent of your salary
reduction for each pay period to be applied to each of your accounts. The total
dollar amount should equal your salary reduction agreement. If percentages are
used, your choices should total 100% The minimum purchase amount per account is
$50.00.
This agreement shall be legally binding and irrevocable with respect to amounts
earned while it is in effect, and supersedes all prior similar agreements.
Unless modified or terminated by written notice, this agreement shall be
applicable to each subsequent employment period. I understand and agree that
during any taxable year I will make no more than one modification to my salary
reduction agreement. However, this agreement may be terminated by written notice
of either party at any time.
Amounts contributed under this Salary Reduction Agreement shall be subject to
the contribution limitations under Section 402(g), 403(b), and 415; and the
distribution restrictions under Section 403(b) of the Internal Revenue Code of
1986 (i.e. distributions cannot be made unless I have attained the age of
59-1/2, suffered a hardship, became disabled, separated from service, or died).
But, I understand that there may be other investment alternatives available
under my employer's Section 403(b) arrangement to which I may elect to transfer
my contract value. I make this agreement to take advantage of Section 403(b) of
the Internal Revenue Code and the tax deferrals therein provided. I am eligible
to elect salary reductions under a 403(b) plan. I understand and consent that
variable annuity contributions will be applied when received in xxxx form at the
AAL Variable Products Service Center.
Employee signature X ________________________________________ Date _____________
B. Approval by Employer The undersigned employer agrees to the modification of
the employee's employment agreement as set out above and further agrees to apply
the salary reduction amount toward the purchase of the variable annuity
designated above by the employee. The employer further agrees that it will
continue to apply the salary reduction amount in a like manner for all future
periods of employment until written notice to the contrary is received from the
employee. Employer certifies that it is a qualifying organization described in
Section 403(b)(1)(A) of the Internal Revenue Code.
Authorized signature X ______________________ Title _____________ Date_________
Distribution:
Original - Employer
Canary - AAL Variable Products Service Center
0000 Xxxxx Xxxxxxx Xxxx
Xxxxxxxx, XX 00000-0000 AID ASSOCIATION FOR LUTHERANS
Pink - Member
Goldenrod - AAL District Representative
0000 X. Xxxxxxx Xxxx, Xxxxxxxx, XX 00000-0000
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Representative's name
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V5245 R2-98
