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Plan #: G12345
Plan: Demo Plan

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10:30 AM  ET

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Change Deferral Election
Change Deferral Elections

Change Deferral Percent

I hereby authorize my employer to reduce my wages, salary, earnings and/or bonus, as indicated below and that this reduction will be a contribution under the Plan established by my employer. This agreement applies to amounts earned until changed by me through OneAmerica TeleServe®, the Internet, or by paper form.

In the event that AUL has all the information necessary to establish my participant account, and my employer is not directing the investment of contributions, and AUL has NOT received my complete Investment Option Election form, I hereby direct that AUL apply any contributions received on my behalf to the plan level default **. This election shall continue in effect until a properly completed Investment Option Election form is received by AUL.

My compensation shall be reduced by the following percentage per pay period.

Please select percentage. Please refer to your Summary Plan Description for the deferral percentages permitted by your plan or speak with your company's Plan Administrator.

Enter New Deferral Percentage
Deferral Percent :   %


** Your request to change your percentage will be communicated to your employer. The effective date of this change will be determined by your employer and is dependent upon plan document provisions.


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