401(k) Enrollment FormCHANCELLOR & CHANCELLOR, INC. 401(K) PLANEmployee Name: __________________________________________
Employee Social Security Number: ________________________
State: ______
Enrollment Date: ________________________________________
Date of Hire: ___________________________________________
Date of Birth: __________________________________________
Annual Income: __________________________________________
I wish to defer ___________% of pay.
(maximum deferral is 10% with a cap of $11,000 for 2002)
INVESTMENT ALLOCATION Strong Government Securities ______% Janus Flexible Income Fund ______% Janus Balanced Fund ______% Lexington Corporate Leaders ______% Janus Fund ______% Janus Worldwide ______% Schwab 1000 Fund ______%
CHANGES TO INVESTMENT ALLOCATION
To make changes, please fill out the above INVESTMENT ALLOCATION section with your current contributions. Below, please fill in the contributions you would like to have your 401(k) changed to. Please specify: ( ) I would like these to be new contributions effective on or after the change date.
( ) I would like these changes to be effective for old and new account balances.
Strong Government Securities ______% Janus Flexible Income Fund ______% Janus Balanced Fund ______% Lexington Corporate Leaders ______% Janus Fund ______% Janus Worldwide ______% Schwab 1000 Fund ______%
PLAN PARTICIPATION CHOICE
YES! I wish to participate and I authorize payroll deductions for this purpose.
Sign Here ____________________________________ Date __/__/__
NO! I do not wish to participate.
Sign Here ____________________________________ Date __/__/__
FOR OFFICE USE ONLY:EMPLOYER APPROVAL SIGNATURE
Sign ____________________________________ Date __/__/__
ID NO. __________ PAY PERIOD/YR. __________
(To enroll, you may print out this page from your browser or cut & paste into a word processor, fill in your information including your signature, and fax/e-mail or mail us the completed form.)