S T A T E O F C A L I F O R N I A SAVINGS PLUS PROGRAM

Transcription

1 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM 457 Deferred Compensation Plan BENEFIT PAYMENT APPLICATION Many of the decisions you make relating to receiving benefits payments from your 457 DCP have restrictions, such as the commencement date and method of payment. Your decisions will have financial consequences as well as income tax implications. Therefore, you may wish to obtain the advice of a professional tax advisor and/or retirement planner before you request a payment of your benefits. This package contains these forms: 457 Deferred Compensation Plan Benefit Payment Application 457 Deferred Compensation Plan Beneficiary Designation Form Direct Deposit Application Specific Investment Designation Certification to Delay Commencement of Payments Annuity Quotation Request Form Annuity Purchase Application IRS FormW-4 Employee s Withholding Allowance Certificate These instructions summarize the Federal and State of California tax rules that may apply to your payment. The tax rules are complex and contain many conditions and exceptions that are not included in these instructions. Therefore, you may want to consult with a professional tax advisor and/or retirement planner before you request a payment of your benefits from the Plan. You can find more specific information on the tax treatment of payments from qualified retirement plans in Internal Revenue Service (IRS) Publication 575, Pension and Annuity Income, and IRS Publication 590, Individual Retirement Arrangements. These publications are available from your local IRS office or by calling TAX-FORM ( ). DC-3516 (12/00) 1

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3 PAYMENT METHODS LUMP SUM PAYMENT A request for a lump sum payment means that a check will be issued to you for your entire account balance. Lump sum payments are reported to the IRS as ordinary income. You may submit a W-4 form for tax withholding. Your lump sum payment check will be mailed to your address as indicated on your Benefit Payment Application (BPA) and will change your address of record. A W-4 form is included in this packet or can be requested from NRS or received from the Internal Revenue Service. PARTIAL LUMP SUM PAYMENT This option allows you to select a specific dollar amount (partial lump sum) upon your commencement date and your choice of periodic payments for a fixed number of years or for a fixed amount. Or you may select a partial lump sum payment and purchase an annuity with the remainder. Partial Lump Sum payment with the remainder as Periodic payments If you select to receive the balance of your 457 DCP in periodic payments, the periodic payments must begin no later than December 31 st of the year following your partial lump sum payment. Please review the Periodic Payment instructions to determine the frequency and amount of your periodic payments. Your partial lump sum check will be mailed to your address as indicated on your BPA and will change your address of record. Example: If you elect to receive a partial lump sum payment in October 2000, with the remainder in periodic payments, you will have to begin the periodic payments no later than December Partial Lump Sum Payment with the remainder as an Annuity Purchase If you choose to purchase an annuity, the premium amount (purchase price of the annuity) will be the remaining value of your account after the partial lump sum is deducted. Please review the information in this package on Annuities and submit the Annuity Quotation Request form to Nationwide Retirement Solutions (NRS) before submitting the payment application packet. Example: If your account balance is $100,000 and you elect to receive $15,000 as a partial lump sum payment, the premium amount for your annuity purchase will be $85,000 (the remaining value of your account). PERIODIC PAYMENTS The Periodic payment option permits you to choose monthly or annual payments. You can specify either:! Fixed Period the length of time over which you will receive your funds; or! Fixed Amount the specific dollar amount that you designate Payments may be spread over a minimum of one year and maximum of your life expectancy, or, the combined life expectancy of you and your beneficiary. Refer to the Life Expectancy Charts in this package. Funds are withdrawn from your account on the designated day you elect to create your periodic payment. See page 7 (Payment Dates) for more information on the NRS periodic payment process. Investment Options and periodic payments If you have monies in more than one investment fund, your periodic payments will be prorated among all of your core options unless you elect a Specific Investment Designation. The Specific Investment Designation allows you to choose one of your existing funds from which your periodic payments will be withdrawn. Only one payment (check or direct deposit) will be issued, regardless of the number of investments you maintain. Personal Choice Retirement Account (PCRA) 1 If you have assets in a PCRA, your selected method of payment applies to both the PCRA and your core account. Your account value for all purposes includes the total value of your core account plus the value of your PCRA. Payments will be 1 Formerly known as the Self Directed Account. 3

4 made from your core account only. You are not required to liquidate all PCRA assets before payments begin. However, you must retain sufficient assets in your core account to cover the upcoming three months of distributions or 50% of your total account value, whichever is greater. PERIODIC PAYMENT METHODS Fixed Period Payments You can choose to receive monthly or annual payments. Your payments are calculated by dividing your account balance by the number of payments that you wish to receive. Your payments will be recalculated each month (if on monthly payout), or each year (if on annual payout), so your account balance will be exhausted at the end of your payment schedule. Example: Lois retired with a 457 DCP account of $50,000. She elected to receive 10 annual payments. Assume an annual account growth rate of 6% your account will be distributed per its actual rate of growth. Payout Year Account Balance $50,000 47,700 44,944 41,685 37,873 33,454 28,369 22,553 15,938 8,447 Annual Payment $5,000 5,300 5,618 5,955 6,312 6,690 7,092 7,517 7,969 8,447 Fixed Amount Payments This option allows you to receive payments of the same amount within each year. Beginning the second calendar year, your fixed amount will increase each year based on the federally defined Cost of Living Adjustment (COLA). If your payments continue beyond age 70½, your payment amount may increase to ensure that your funds are paid within your life expectancy in accordance with Internal Revenue Code regulations. Your life expectancy, for purposes of the Fixed Amount Payment option, will be based on the birth dates you provide. You may only use your designated beneficiary s birth date or age in combination with your own for determining your joint life expectancy. If you have multiple designated beneficiaries you may only use the eldest beneficiary s birth date or age in determining your joint life expectancy. If you do not wish to select a joint life expectancy do not provide your beneficiary s birth date. The SPP will automatically use your single life expectancy if you only provide your birth date. Minimum Fixed Amount Requirement Your specified dollar amount must be at least equal to the following: Annual Payments Divide your current account value by the number of years according to your life expectancy. Monthly Payments Divide your current account value by the number of years according to your life expectancy. Divide the dollar value you arrived at by 12 (number of months in the year). Example #1 Example #2 Example #3 Bob has a current balance of $40,000 and is selecting Fixed Amount payments of $2,000 annually. He is sixty-five years old with a single life expectancy of twenty years. Since his Fixed Amount is equal to the amount derived by dividing his account balance by his life expectancy ($40,000 divided by 20 years = $2,000), his request would comply with the requirement. Sally has a current balance of $60,000 and is selecting Fixed Amount payments of $1,500 monthly. She is currently fifty-five years old and her spouse is sixty-two years old therefore she has a joint life expectancy of thirty-one years. Since her Fixed Amount is more than the amount derived by dividing her account balance by her joint life expectancy divided by twelve months ($60,000 divided by 31 years = $1,935 divided by 12 months = $161), her request would comply with the requirement. Marie has a current balance of $35,000 and is selecting Fixed Amount payments of $1,000 annually. She is currently fifty-seven years old with a single life expectancy of twenty-six years. Since her Fixed amount is less that the amount derived by dividing her account balance by her life expectancy ($35,000 divided by 26 years = $1,346), her request would not comply with the requirement. 4

5 Annual test at age 70½ If there are funds remaining in your account at age 70½, an annual test will be performed to determine if your payments at the current rate will extend beyond your life expectancy. This test is performed by dividing the value of your account balance on the last working day in December (beginning in the year you attain age 70½) by the maximum number of payments allowed, pursuant to your life expectancy. If the test determines that the life expectancy dollar amount is greater than the predetermined fixed dollar amount (including COLA increase), your payment amount will increase accordingly. Why an annual test at age 70½ is performed Section 457 of the IRC incorporates the required minimum distribution regulations of Section 401(a). These sections require your funds to be distributed within your applicable single or joint life expectancy. An adjustment to increase your payment amount may be necessary to ensure payments do not extend beyond your life expectancy. PURCHASE OF AN ANNUITY If you are considering the purchase of an annuity with your 457 Deferred Compensation Account, you must first complete the attached Annuity Quotation Form and submit to NRS. Several types of fixed annuities are available through Savings Plus. NRS will mail the quotations within 7-10 business days. Annuity quotations disclose how much you would receive each month from each form of annuity, based on a given premium. The amount of the monthly payment will depend on the form of annuity, the annuity provider, and premium amount for purchase. What is an Annuity? An annuity is a binding agreement between an individual (the annuitant) and a specific life insurance company. The life insurance company agrees to provide fixed monthly payments for the annuitant s lifetime (variable annuities are not available through this plan). The annuity is purchased with a single cash payment (the premium) in return for guaranteed monthly payments commencing immediately. Annuity purchases are subject to the following charges: An administrative fee to the insurance company. The tax laws of some states, including California, require that a premium tax be paid on the purchase of all annuities. The tax rate is set by the California Constitution as a percentage of the purchase price. As of the date this package was printed, the premium tax for the 457 Plan is 2.35%. Insurance companies issuing annuities deduct the amount of this premium tax from the gross proceeds of your 457 account and apply the net proceeds to the purchase of your annuity. Forms of annuities Life Only: The annuitant receives monthly payments commencing immediately and continuing throughout his/her lifetime. There will be no benefits payable to a beneficiary after the annuitant s death. Period certain and life: A specific term of 5, 10, or 15 years is selected when the annuity is purchased. The annuitant receives monthly payments throughout his or her lifetime. If he or she dies within a 5-year, 10-year, or 15-year period, the designated beneficiary will receive payments equal to the amount the annuitant was receiving for the remainder of the term. If the annuitant dies after the 5-year,10-year or 15-year period, the designated beneficiary will not receive any benefits pursuant to this option. Life with installment refund: The annuitant receives monthly payments throughout his or her lifetime. If he or she dies, the difference (if any) between the amount paid to purchase the annuity and the total amount received will be paid in a lump sum to the designated beneficiary. Joint and survivor : This form of annuity is purchased with either 50% or 100% survivor benefits. The primary annuitant receives monthly payments throughout his or her lifetime. In the event the primary annuitant dies, the survivor annuitant continues to receive payments throughout his or her lifetime at either 50% or 100% of the amount paid to the primary annuitant. Period certain with joint and survivor: This form of annuity is purchased with either 50% or 100% survivor benefits, and it requires the primary annuitant to name a survivor annuitant (usually the primary annuitant s spouse). This form of annuity also has a term of 5, 10, or 15 years, selected when the annuity is purchased. The primary annuitant receives monthly payments throughout his or her lifetime. If the primary annuitant predeceases the survivor annuitant within a 5-year, 10-year, or 15-year period, the survivor annuitant will receive payments equal to the amount the primary annuitant was receiving for the remainder of the term. At the end of the term, the survivor annuitant will receive payments for the remainder of his or her lifetime at either 50% or 100% of the amount paid to the primary annuitant. If both the primary annuitant and the survivor annuitant die within the term 5

6 selected, payments will be made to a secondary beneficiary for the rest of the term, in the same amount the primary annuitant was receiving. GENERAL INFORMATION Changing the method of payment You can change the method of payment before payments begin by providing a written notice to this effect to NRS at least 60 days before your first payment. Once your payment schedule has begun, Internal Revenue Code (IRC) regulations and the annuity providers prohibit the suspension of payment and any change in the method of payment. You may not close out your deferred compensation account any earlier than the final payment determined according to the payment schedule you selected, unless you meet the eligibility criteria for an Unforeseeable Emergency Withdrawal. If you are granted an Unforeseeable Emergency Withdrawal, your account balance will be reduced by the amount granted; however, your payment schedule will remain the same. Specific Investment Designation (Optional Partial Lump Sum and Periodic Payments Only) Specific investment designations only apply to Partial Lump Sum and Periodic (Fixed Amount or Fixed Period, monthly or annual) payments. The designation of a specific investment is optional. Do not complete a designation if you want your periodic payments to be prorated from all of your core investments, or if you have monies in only one core option. You are responsible for ensuring the investments you designate has a value sufficient to satisfy the full payment amount. If, on the day assets will be surrendered to create the payment being made, the amount of the periodic payment exceeds the value of the investment designated, this designation shall be deemed void. Your periodic payments will then be prorated from among all of your core funds. You will be notified by mail when and if this occurs. All future periodic payments will also be prorated from among your core account until you submit a new Specific Investment Designation form. Annual review of the account occurs in January. If the payment is for a greater amount than the investment has available, the withdrawal would be pro-rated from the core account. You may submit a new designation at any time while you are receiving periodic payments. NRS must receive the completed designation no later than the month prior to make the change effective with your next periodic payment. Direct Deposit Information (Periodic Payments Only) You may request direct deposit if you are requesting periodic payments. If you are requesting a partial lump sum with the remainder of your account paid in periodic payments, you can use this section to have only your periodic payments directly deposited. Account Information If your payment is to be deposited into a checking account, you must attach a check marked VOID to your Direct Deposit Form. ACH Routing Number Include the nine-digit Automated Clearinghouse (ACH) routing number for your bank. If you leave the routing number blank but complete the remainder of this section, a check will be mailed to your bank. The fee for mailing each check is $2.00. Bank Mailing Address Your bank s mailing address is required for your first periodic payment to be mailed to your bank before direct deposit begins in the event your application is processed too late to make the first payment by direct deposit. No fee will be charged for mailing this first check to your bank or for any payment made by direct deposit. Updating and changing your direct deposit information You are responsible for providing the above information and updating it as needed. If the account number changes, you must submit a direct deposit form with the correct account number. The same applies if your bank name, bank mailing address, account type, or routing number changes. Instructions to change this information will not be accepted from anyone other than the participant, including your bank. If problems occur with direct deposit NRS will notify you if your bank reports any problems with the direct deposit process. Your direct deposit request will be cancelled and checks will be mailed to your mailing address of record until we receive a new direct deposit form. The fee for mailing each check is $

7 Payment Dates Payments are processed and issued on the designated day you elect. Assets will be surrendered on that date and a check or ACH will be sent according to NRS payment process. Your first payment cannot be processed unless NRS receives all necessary forms at least 60 days before the payment commencement date. NRS directly deposits or mails payments within three (3) working days from the date assets were surrendered. The payments are generated weekly. Payments will be paid based on the date range into which each falls. The date ranges are the 1 st through the 7 th, the 8 th through the 14 th, the 15 th through the 21 st, and the 22 nd through the end of the month. For each date range, the checks will be mailed on the second business day of the range. For example, if you request a payment date on the 20 th day of the month, this date falls between the 15 th through the 21 st. Therefore, NRS will mail a check on the 2 nd business day of the range (the 17 th if it is not on a weekend or holiday). Be sure to allow for appropriate mail or federal reserve processing time for distribution payments. Lost or Stolen checks If a check is mailed to you or your bank, it can be reported lost or stolen if it is not received after 14 days from check issuance. Check mailing fee (periodic payments only) If you have not selected direct deposit to your bank account, your check will be mailed to you or your bank. The fee for mailing each check is $2.00. Certification to Delay Commencement of Payments The Certification to Delay Commencement of Payments allows you to postpone the date your payments begin. You can use this option if you decide that you do not want to begin payments on the date you had originally selected. You may only use the Certification to Delay Commencement of Payments once. The Certification to Delay Commencement of Payments must be received by NRS no later than 30 days before the month in which your first payment is scheduled to begin. American General and Nationwide Accumulation Annuities If you have assets invested in American General and/or Nationwide annuities, please call NRS [(866) ] for an additional application. You must submit a specific American General and/or Nationwide payment application in order to begin your payments. W-4 FORM INSTRUCTIONS The W-4 Form instructs NRS how much State and Federal income tax to withhold from your payments. If you do not complete a W-4 Form, taxes will be withheld at the rate of single with zero allowances. If you choose to complete a W-4, you are required to complete the Employee Withholding Allowance Certificate portion of the W-4 Form. You must enter your name, address, and Social Security Number. You are not required to complete the Personal Allowances Worksheet or the Deductions and Adjustments Worksheet. A W-2 will be issued by January 31 st of the following year for tax reporting purposes. Tax Withholding Information If you live outside of California California cannot impose income tax on your deferred compensation payments if you live in another state. Therefore, State taxes will not automatically be withheld if your mailing address is outside of California. However, if you wish to have State taxes withheld, print a specific instruction in the bottom margin of the W-4 Form. Be sure to specify the state for which you wish to have taxes withheld. The following states do not have State income tax: Alaska, Florida, Hawaii, Nevada, New Hampshire, Pennsylvania, South Dakota, Tennessee, Texas, Washington, and Wyoming. Tax withholding rate Your tax withholding for your deferred compensation payments does not take into account any other income you may receive. At any time you may request a W-4 Form to change your tax withholding. Exemption from withholding 7

8 If you claim exemption from tax withholding in box 7 of the W-4 Form, taxes will not be withheld. However, IRS regulations require you to renew your exempt status by February 15 th of each year. You can do this by requesting, completing, and submitting a new W-4 Form. Failure to do so may result in the change of your tax withholding status to a rate of single and zero allowances. 8

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10 UNISEX - ONE LIFE ACTUARIAL TABLE FOR DETERMINING LIFE EXPECTANCY The following chart should be used to determine your life expectancy. Age Life Expectancy in Years Age Life Expectancy in Years

11 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM 457 DEFERRED COMPENSATION PLAN BENEFIT PAYMENT APPLICATION LAST NAME FIRST NAME MI SOCIAL SECURITY NUMBER ADDRESS PARTICIPANT S BIRTH DATE MONTH DATE YEAR CITY STATE ZIP CODE BENEFICIARY S BIRTH DATE (JOINT LIFE EXPECTANCY) MONTH DATE YEAR RETIREMENT/SEPARATION DATE ADDRESS DAYTIME TELEPHONE NUMBER WITH AREA CODE ( ) Privacy Statement: The Information Practices Act of 1977 (Civil Code Section ) and the Federal Privacy Act (Public Law ) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the Savings Plus Program for purposes of identification and account processing. It is mandatory that you furnish all information requested on this form. Failure to provide mandatory information may result in action requested not being processed. Commencement Date Election Payment will begin on the commencement date you elect. Your commencement date cannot be deferred beyond March of the year after you attain age 70 ½. You may choose to postpone your commencement date, as long as payments have not begun. You may only postpone your commencement date one time. Issue Payment immediately (within 60 days) Issue payment on / / Month Day Year Method of Payment Lump Sum Payment (total account balance) OR; Partial Lump Sum Amount $ AND Periodic Payment (complete the Periodic Payment Method box below) or Annuity Purchase (see note) OR; Periodic Payments (complete the Periodic Payment Method box below) OR; Annuity Purchase (see note) Periodic Payments /Annuity to begin / / MONTH DAY YEAR Periodic Payment Method (select one) Fixed Period Fixed Amount $ specify number of years Monthly payments Annual payments Monthly payments Annual payments Note: You must request an Annuity Quotation and an annuity payment application from NRS before submitting form Participant Certification I request distribution to be made in accordance with the Plan regulations and my election above. I understand it is within the authority of the State of California to approve or disapprove this request. I hereby certify under penalty of perjury that this information is true and accurate to the best of my knowledge. " Signature Date 11

12 457 DCP BENEFIT PAYMENT APPLICATION INFORMATION Commencement Date Election You must elect a commencement date (a date that your payments will begin) and method of payment within 60 days after your date of retirement or separation. (Once your payment begins, you cannot change your payment method or the length of time over which you will receive them. This decision is irrevocable.) However, you may postpone commencement date one time so long as payments have not begun. You cannot receive payment before the original commencement date. Proof of Eligibility to Withdraw Funds Your eligibility to withdraw funds is verified before payment is issued. To facilitate faster processing of your application, you may provide proof of separation. For most State employees, a Notice of Personnel Action (NOPA) is issued to you by your personnel office upon separation. If you do not have a NOPA, a letter from your employer is acceptable. The letter must be on letterhead and reference your date of retirement or separation. Maximum Duration To Defer Payment If you have retired or separated, you must begin payment by March of the year after you attain age 70½. If you have continued State employment beyond age 70½, you may choose to receive payment or to defer payment for a maximum of 60 days (March) after the year in which you retire or separate. Failure to Respond If you do not return the completed application within 60 days, you are deemed to have elected a lump sum payment. Payment will be issued 180 days from date of separation or retirement. Methods of Payment You have a choice of payment methods. Please review the attached material for more information about the options and complete the forms applicable for the payment options you have selected. Payment choices are as follows: Lump Sum Payment Partial Lump Sum payment with remainder as Periodic Payments or Annuity Purchase Periodic Payments Purchase of an Annuity Returning Forms Return all applicable forms with your application. If you wish to purchase an annuity, please enclose a copy of the current annuity quotation for the annuity provider you have selected. Send your completed application and form to: Nationwide Retirement Solutions One Nationwide Plaza PW Columbus, OH

13 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM 457 DEFERRED COMPENSATION PLAN BENEFICIARY DESIGNATION FORM PARTICIPANT INFORMATION LAST NAME FIRST NAME MI SOCIAL SECURITY NUMBER ADDRESS (STREET, CITY, STATE, ZIP CODE) MARITAL STATUS # NOT MARRIED (WIDOWED, DIVORCED, OR SINGLE) # MARRIED DAYTIME TELEPHONE NUMBER ( ) DATE OF BIRTH MONTH DAY YEAR The Information Privacy Act of 1977 (Civil Code Section ) and the Federal Privacy Act (Public Law ) require that this notice be provided when collecting personal information from individuals. The Savings Plus Program uses information requested on this form for purposes of identification and account processing. It is mandatory that you furnish all information requested on this form. Failure to provide mandatory information may result in action requested not being processed. BENEFICIARY INFORMATION I HEREBY DESIGNATE THE FOLLOWING PRIMARY BENEFICIARY(IES) TO RECEIVE MY FUNDS UPON MY DEATH. IN THE EVENT I SURVIVE THE PRIMARY BENEFICIARY(IES) DESIGNATED BELOW, I DESIGNATE THE FOLLOWING CONTINGENT BENEFICIARY(IES) TO RECEIVE MY FUNDS UPON MY DEATH. LAST NAME FIRST NAME MI RELATIONSHIP % SOCIAL SECURITY NUMBER ADDRESS (STREET, CITY, STATE, ZIP CODE) # PRIMARY # CONTINGENT LAST NAME FIRST NAME MI RELATIONSHIP % SOCIAL SECURITY NUMBER ADDRESS (STREET, CITY, STATE, ZIP CODE) # PRIMARY # CONTINGENT LAST NAME FIRST NAME MI RELATIONSHIP % SOCIAL SECURITY NUMBER ADDRESS (STREET, CITY, STATE, ZIP CODE) # PRIMARY # CONTINGENT # Additional beneficiaries are listed on an attached sheet of paper (identified as Primary or Contingent). A Trust can be named as a primary beneficiary or a contingent beneficiary. A trust can also be designated to be a Sole beneficiary or to Share and Share Alike with co-beneficiaries. Please indicate in the appropriate boxes how you want your trust to be designated. TRUST INFORMATION TRUST NAME DATE OF TRUST % # PRIMARY # CONTINGENT ADDRESS (STREET, CITY, STATE, ZIP CODE) NAME OF TRUSTEE PARTICIPANT CERTIFICATION I hereby certify under penalty of perjury that the information on this form is true and accurate to the best of my knowledge. " SIGNATURE DATE [DC-3496 (12/00)] 13

14 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM 457 DEFERRED COMPENSATION PLAN BENEFICIARY DESIGNATION FORM INSTRUCTIONS Please read carefully before completing the designation. To designate a beneficiary, complete and sign the Beneficiary Designation form. Any change, including the address of a beneficiary, requires that you submit a completed Beneficiary Designation form. Changes will be effective upon receipt. Please retain a copy for your records. If you fail to designate a specific beneficiary(s), your account will be paid to your Estate or Trust. You may designate as many primary beneficiaries as you wish. If needed, attach an additional sheet of paper that includes your social security number, signature, and the date. You are not required to provide your beneficiary s social security number, however, the absence of that number may hinder the ability to locate/identify your beneficiary. If more than one Primary Beneficiaries is listed, your funds will be divided equally unless you clearly state otherwise. Should a primary beneficiary predecease you, funds will be paid/divided among any remaining primary beneficiaries designated. If there are no primary beneficiaries, funds will be paid/divided among any contingent beneficiaries designated. You may designate as many contingent beneficiaries as you wish. The contingent beneficiaries will not receive any portion of your funds if any primary beneficiary is living. If more than one contingent beneficiary is listed, your funds will be divided equally unless you clearly state otherwise. You may designate a trust as your beneficiary to be paid in lieu of your estate. Special rules may apply to estates and trusts. You are advised to contact a tax or estate planning professional before designating your estate or trust as beneficiary. Your beneficiary designation generally supercedes any other designation such as by a Will, Trust, Estate, etc. It is extremely important that you keep your designation consistent with your wishes. Nationwide Retirement Solutions One Nationwide Plaza PW Columbus, OH Voice Response System: (866) available 24 hours per day, 7 days per week Customer Service (866) available 8:30 a.m. 4:00 p.m. Monday Friday TDD (916) [DC-3496 (12/00)] 14

15 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM SPECIFIC INVESTMENT DESIGNATION PARTICIPANT INFORMATION LAST NAME FIRST NAME MI SOCIAL SECURITY NUMBER ADDRESS ADDRESS CITY STATE ZIP CODE DAYTIME TELEPHONE NUMBER WITH AREA CODE ( ) Privacy Statement: The Information Practices Act of 1977 (Civil Code Section ) and the Federal Privacy Act (Public Law ) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the Savings Plus Program for purposes of identification and account processing. It is mandatory that you furnish all information requested on this form. Failure to provide mandatory information may result in action requested not being processed. SPECIFIC INVESTMENT DESIGNATION I understand that all payments will be withdrawn from one specified investment option, so long as the value of the option is sufficient for the payment amount. Please withdraw my periodic payment from the option checked below: Dwight Asset Management Guaranteed Insurance Contract Savings Pool CalPERS U.S. Treasury Short-Term Fund CalPERS U.S. Treasury Intermediate-Term Bond Vanguard Total Bond Market Index Fund Vanguard GNMA Fund Hartford Advisors HLS Fund Domini Social Equity Fund Hartford Stock Fund HLS Fund CalPERS S & P 500 Index Fund Vanguard U.S. Growth Fund Federated Stock Trust Institutional Fund T. Rowe Price Mid-Cap. Growth Fund Accessor Small to Mid-Cap. Fund Franklin Balance Sheet Investment Fund Glenmede Institutional International Equity Fund Investor Destinations Conservative Fund Investor Destinations Moderately Conservative Fund Investor Destinations Moderate Fund Investor Destinations Moderately Aggressive Fund Investor Destinations Aggressive PARTICIPANT CERTIFICATION I authorize Savings Plus to withdraw my payments from the investment options designated above. I certify I have read the Privacy Statement and the instructions on completing this designation and agree to all the terms. " SIGNATURE DATE 15

16 INSTRUCTIONS FOR COMPLETING THE SPECIFIC INVESTMENT OPTIONS DESIGNATION FORM 1. Specific investment designations only apply to partial lump sum and periodic (fixed amount or fixed period, monthly or annual) payments. Specific investment designations do not apply to Lump Sum payments or to the purchase of an annuity. 2. The designation of a specific investment is optional. Do not complete a designation if you want your periodic payments to be prorated from all of your core account, or if you have assets in only one core option. 3. You are responsible for ensuring the investment you designate has a value sufficient to satisfy the full payment amount. If, on the day that assets will be surrendered to create the payment being made, the amount of the periodic payment exceeds the value of the fund you have designated, this designation shall be deemed void. Your periodic payments will then be prorated from among all of your core funds. You will be notified by mail when and if this occurs. All future periodic payments will also be prorated from among all of your core funds until you submit a new Specific Investment Designation form. 4. You may submit this designation at any time while you are receiving periodic payments. The recordkeeper must receive the completed designation no later than the month prior to make the change effective with your next periodic payment. Note: You may not change the designated fund or cancel this designation once submitted, except as indicated above. If you have any questions, please call (866) between 8:30 a.m. and 4:00 p.m., Monday - Friday to speak with a Customer Service Representative. RETURN FORM TO : Nationwide Retirement Solutions One Nationwide Plaza PW Columbus, OH

17 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM DIRECT DEPOSIT FORM New (ESTABLISHES DIRECT DEPOSIT) Change (MODIFIES EXISTING DIRECT DEPOSIT INFORMATION) Cancel Direct Deposit (A check will be mailed to address of record) Participant Information LAST NAME FIRST NAME MI SOCIAL SECURITY NUMBER ADDRESS DATE OF BIRTH CITY STATE ZIP CODE DAYTIME TELEPHONE NUMBER WITH AREA CODE ( ) Privacy Statement: The Information Practices Act of 1977 (Civil Code Section ) and the Federal Privacy Act (Public Law ) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the Savings Plus Program for purposes of identification and account processing. It is mandatory that you furnish all information requested on this form. Failure to provide mandatory information may result in action requested not being processed. ACCOUNT INFORMATION Account Type: Checking (Check marked void attached) Savings ACH Routing Number (9 digits) Account Number (Not to exceed 17 digits) BANK INFORMATION BANK NAME BANK MAILING ADDRESS CITY STATE ZIP CODE PARTICIPANT CERTIFICATION I authorize Savings Plus to make direct deposits to the account identified above effective immediately. I certify I have read the instructions on completing this application and the information regarding direct deposits " SIGNATURE DATE 17

18 INSTRUCTIONS FOR COMPLETING THE DIRECT DEPOSIT FORM: 1. Check New if this direct deposit application establishes a direct deposit. 2. Check Change if this direct deposit application modifies existing direct deposit information. 3. Check Cancel Direct Deposit if you no longer wish to receive a direct deposit. A check will be mailed to your address of record. A $2.00 fee will be charged for mailing each check. 4. Participant Information Provide all information requested. 5. Account Information Include the nine-digit Automated clearinghouse (ACH) routing number for your bank. Attach a check marked void for an electronic fund transfer to your checking account. Attach a deposit slip marked void for an electronic fund transfer to your savings account. If you do not have a savings account deposit slip, it can be obtained from your banking institution. Include your account number. 6. Bank Information Provide the name and mailing address of your bank. The bank mailing address is necessary because we may mail a check to your bank before the direct deposit begins. 7. Participant Signature Sign and date the application. INFORMATION: 1. Direct deposit is available for periodic (annual or monthly) payments only. Lump sum and partial payments will be mailed to your address of record. 2. You are responsible for providing the direct deposit information and updating it as needed. If your account number changes, you must submit another direct deposit application with the correct account number. The same applies if your bank name, bank mailing address, account type, or routing number changes. 3. Changes to these instructions will not be accepted from anyone except you, including your bank. Your signature is required to change or cancel your direct deposit. 4. We will notify you if your bank reports any problems with the direct deposit process. We will cancel your direct deposit request if this occurs. We will then mail payments to your mailing address of record until we receive a new direct deposit application. The fee for mailing each check is $ If you submit a completed application 30 days or more before your first payment, the first payment can usually be made through direct deposit. If you are already receiving payments, direct deposit changes will begin days after the completed application is received. We will mail one payment to your bank free of charge. After that time, we will make payments through direct deposit. If you have any questions, please call (866) between 8:30 a.m. and 4:00 p.m., Monday - Friday to speak with a Customer Service Representative. RETURN FORM TO: Nationwide Retirement Solutions One Nationwide Plaza PW Columbus, OH

19 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM CERTIFICATION TO DELAY COMMENCEMENT OF PAYMENTS The Federal Small Business Job Protection Act of 1996 was signed into law effective January 1, This law made several favorable changes to Internal Revenue Code section 457 with authorizes and regulates the tax aspects of deferred compensation programs for state and local government employees. Specifically, if you separated or retired and had elected a commencement date of January 1997 or later for distribution from your account, the law permits a one-time delay in the election of the commencement date. The new commencement date becomes irrevocable. Payment must commence by March of the year after you attain age 70 ½. PARTICIPANT INFORMATION LAST NAME FIRST NAME MI SOCIAL SECURITY NUMBER ADDRESS DATE OF BIRTH MONTH DAY YEAR CITY STATE ZIP CODE DAYTIME TELEPHONE NUMBER WITH AREA CODE ( ) Privacy Statement - The Information Practices Act of 1977 (Civil Code Section ) and the Federal Privacy Act (public Law ) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the Savings Plus Program for purposes of information and account processing and will be kept confidential in accordance with the Information Practices Act. It is mandatory that you furnish all information requested on this form. Failure to provide such information may result in actions requested not being processed. COMMENCEMENT DATE CHANGE THIS DATE CAN ONLY BE POSTPONED, NOT ACCELERATED. Original commencement date: New commencement date: PARTICIPANT CERTIFICATION I certify I have read the information and understand that my signature below authorizes Savings Plus to delay the start date of my deferred compensation distribution. I understand that this certification is irrevocable as this date can only be postponed not accelerated and that payment must commence by March of the year after I attain age 70 ½. " SIGNATURE DATE If you have any questions, please call (866) between 8:30 a.m. and 4:00 p.m. to speak with Customer Service Representative. RETURN FORM TO: Nationwide Retirement Solutions One Nationwide Plaza PW Columbus, OH

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21 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM ANNUITY QUOTATION REQUEST FORM SECTION 1 ANNUITANT INFORMATION Name Street Address City/State/Zip Code Social Security Number Home Phone Number Work Phone Number Participant s Date of Birth Survivor s Date of Birth Gender Month day year Month day year Male Female Privacy Statement The Information Practices Act of 1977 (Civil Code Section ) and the Federal Privacy Act (public Law ) require that this notice be provided when collecting personal information from individuals. Information requested on this form is used by the Savings Plus Program for purposes of information and account processing and will be kept confidential in accordance with the information Practices Act. It is mandatory that you furnish all information requested on this form. Failure to provide such information may result in actions requested not being processed. SECTION 2 ANNUITY INFORMATION AND QUOTATIONS REQUESTED Date payments are expected to begin (Commencement Date): Month/Year / Please indicate # 401 (k) Thrift Plan Account Balance $ # 457 Deferred Compensation Plan Account Balance $ ANNUITY TYPE Life Only Period Certain and Life 5 years 10 years 15 years Life with Installment Refund Joint and 50% Survivor Joint and 100% Survivor Period Certain 5 years 10 years 15 years WITH Joint and 50% or Joint and 100% Survivor ANNUITY PROVIDERS Please submit your annuity quotation request directly to NRS. Allow at least 7 business days for the quotation to be mailed to you from NRS. You will receive a quotation and product information from each of the following: Hartford Life Insurance Company Metropolitan Life Insurance Valic Life Insurance Travelers Life Insurance Principal Capital Management " SIGNATURE DATE DC-3502 (12/00) 21

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23 STATE OF CALIFORNIA SAVINGS PLUS PROGRAM ANNUITY PURCHASE APPLICATION SECTION 1 ANNUITANT INFORMATION Please indicate # 457 Deferred Compensation Plan457 Deferred Compensation Plan # 401(k) Thrift Plan Name Street Address City/State/Zip Code Social Security Number Home Phone Number Work Phone Number Date of Birth Month date year Marital Status # Married # Single Gender # Male # Female SECTION 2 ANNUITY PAYMENT INFORMATION (Indicate Name) PURCHASE ANNUITY FROM: TOTAL PREMIUM (FROM QUOTE): $ MONTHLY BENEFIT (FROM QUOTE): ANNUITY START DATE: ANNUITY TYPE: # Life Only $ # Period Certain & Life # 5 years # 10 years # 15 years # Life with Installment Refund # Joint and 50% Survivor # Joint and 100% Survivor # Period Certain # 5 years # 10 years # 15 years with # Joint and 50% or # Joint and 100% Survivor SECTION 3 SURVIVOR DATA Name (Complete only if Joint & Survivor Annuity is selected) Social Security Number Street Address Home Phone Number City/State/Zip Code Date of Birth 23 Month day year Relationship to Participant # Spouse # Other DC-3503 (12/00)

24 SECTION 4 BENEFICIARY DESIGNATION If Spouse-Survivor Annuity is indicated in Section 3, the Spouse-Survivor Annuitant will also be the primary beneficiary of any Death Benefits before considering payment to any beneficiary. If you wish to name multiple primary beneficiaries or a contingent beneficiary(ies) to receive benefits in the event the primary beneficiary(ies) predeceases you, attach a separate sheet showing the name, date of birth, relationship, social security number and mailing address for each listed beneficiary. Primary Beneficiary Name Street Address City/State/Zip Code Relationship to Participant # Spouse # Other Social Security Number Home Phone Number Date of Birth Percentage of Proceeds % SECTION 5 ANNUITANT CERTIFICATION I hereby direct that my entire # 401(k) Thrift Plan # 457 Deferred Compenation Plan account balance be used to purchase the applied for annuity. I acknowledge that I may be charged an administrative fee, the dollar amount may vary depending on the company selected. A state premium tax will be assessed, if applicable, based on the state in which I reside. The state premium tax in California is 0.5% for the 401(k) Plan and 2.35% for the 457 Plan. I understand that in order to defer income tax liability until each periodic annuity payment is received, the State of California must retain ownership of the annuity and that the value of any annuity benefits not yet paid must remain subject to general creditor claims against the State of California. I certify that the information I have provided for the purchase of this annuity is true and correct and that the insurance company has the right to recover any benefits paid to me in error as a result of any false statements. I further certify that I fully understand the annuity payment option I have selected. " Annuitant Signature Date SECTION 6 SPOUSAL WAIVER (must be completed if purchasing other than a survivor benefit) I acknowledge the Beneficiary Designation named on this form. I understand the terms of this contract and that I will not receive benefits in the event my spouse, as the Annuitant, predeceases me. " Signature of Spouse Date 24

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