SRA Logo
Please Note: The form below does require Javascript. Please ensure that the Javascript setting is enabled for this website on your web browser. Thank you! 
Personal Information
Effective dates are subject to the payroll schedule of your Employer.
Plan Information
Please note: If your plan belongs to a Multi-Employer Group, the Employer Name will be that of the Sponsoring Plan. 

If you do not see your employer's plan when you start typing in the field above, your plan may submit SRAs directly to the Investment Provider rather than through ADMIN Partners. Please contact your payroll administrator for further information.
Contribution Information
Please Note: This Plan does allow for the 15 year of service election

Employee agrees and acknowledges contributions are subject to annual limits determined under Internal Revenue Code (IRC) Section 402 (g) and 415 (c). Institutions may limit contributions in order to comply with federal law. Employee hereby directs that any contribution in excess of such limits be returned in accordance with the governing legal requirements. 

Contribution Details
Please list the account to which salary reduction contribution should be allocated. Allocations listed below will supersede any previous allocations for salary reduction contributions. You can add additional accounts by clicking "add another vendor".

Note: If you do not see the Roth/Post-Tax contribution option, your plan may not allow for this type of salary reduction. Please contact ADMIN Partners for any questions related to plan provisions. 
Begin typing the provider name.
                Employee
          Deferral Amount 		        Employee Roth
     (Post-Tax) Amount
Contribution Details
Please list the account to which salary reduction contribution should be allocated. Allocations listed below will supersede any previous allocations for salary reduction contributions. You can add additional accounts by clicking "add another response".
Begin typing the provider name.
                Employee
        Deferral Percentage 		             Employee Roth
       (Post-Tax) Percentage
                           Don't include % sign.
                  Don't include % sign.


Agreement and Important Information
By signing this Agreement, Employee agrees to modify his/her salary as indicated above and Employer agrees to contribute this amount on Employee’s
behalf into the applicable Plan investments selected by Employee with the proper identification of pre-tax contributions and after-tax contributions to aid in
proper allocation to segregated accounts by the Provider(s). It is intended that the requirements of all applicable state and federal tax rules and regulations
(Applicable Law) will be met.

The Employee understands and agrees that this Agreement:
Is legally binding and irrevocable with respect to amounts paid or available while it is in effect; 2. May be terminated at any time for amounts not yet paid or
available, and that a termination request is permanent and remains in effect until a new salary reduction agreement is submitted; 3. Is effective only for
amounts not yet earned or made available in accordance with the Employer’s administrative procedures.

Employee further agrees that:
He/she may be assessed fees associated with administering the Plan either directly by the product vendor or by payroll deduction. He/she is responsible for
determining that his/her salary reduction amount does not exceed the limits of the applicable law and is further responsible for the requirement that any
after-tax contributions to a Roth option be segregated into a separate account that is separately tracked and monitored.

He/she is responsible for the accuracy of the information provided by Employee, which is used in determining Employee’s maximum annual contribution
limit; and Employer has no liability for any losses suffered by Employee that result from his/her participation in the Plan.

Employee acknowledges that Employer has made no representation to Employee regarding the advisability, appropriateness or tax consequences of the
Plan investment(s) selected by the Employee. Nothing herein shall affect the terms of employment between Employer and Employee.

This agreement supersedes all prior salary reduction agreements and shall automatically terminate if your employment with the Employer is terminated.

Important Information
  1. Employer does not choose any products in which contributions are invested nor does it endorse, promote or in any way guarantee any investments in the Plan.
  2. Employees are responsible for setting up and signing the legal documents to establish the annuity contract or custodial account. However, in certain group annuity contracts, Employer may be required to establish the contract.
  3. In order to receive the expected tax results, Employees are responsible for investing in appropriate products that meet the requirements of the applicable Sections of the Internal Revenue Code.
  4. Employees are responsible for naming a death beneficiary under the applicable Plan. This is normally done at the time the investment vehicle is established. Beneficiary designations should be reviewed periodically.
  5. Employees are responsible for all distributions and any other transactions with their service provider. All rights under the investment(s) are enforceable solely by Employee, Employee beneficiary or Employee’s authorized representative. Employee must work directly with the service provider to transfer contract(s) or custodial account(s) to another service provider, begin distributions, make loans, or otherwise access Plan assets.
  6. Employees are responsible for determining that salary reductions do not exceed the allowable contribution limits under Applicable Law. References herein to elective deferral limits are based on the current IRS Limits.