The University of Akron s8

403(b) Salary Reduction Agreement Office of the Associate VP/Controller - Payroll Office Section 1: Employee Information

Name (Last, First, M): Mail Phone number or Employee ID number: zip: + extension:

Section 2: Salary Reduction

I authorize The University to reduce my salary in the amount specified below effective on or after:

I authorize The University to reduce my sick/vacation/compensatory time payoff in the amount specified below. I understand that a specific amount must be given. If assistance is needed in determining the amount, contact the Payroll Office at ext. 7205.

I wish to terminate my salary reduction with the following carrier(s):

Pre-tax After-tax Pre-tax After-tax 403(b) carrier amount amount per 403(b) carrier amount amount per per pay pay (Roth) per pay pay (Roth) Ameriprise N/A MetLife Insurance N/A Midwest Annuity & AXA Equitable Investment N/A D&E Financial Services: The Milestone Center: FTJ Fund Choice N/A Midland National N/A Midland National N/A Voya Reliastar N/A Voya Reliastar N/A PFS Investments Great American N/A TIAA-CREF Lincoln Financial Advisors VALIC Life Ins. Co. of the Southwest Voya Financial Partners, Inc.

Massachusetts Mutual Women’s Life N/A

Section 3: Authorization

As a participant under The University of Akron’s Plan, the Employee hereby elects to direct the investment of their account balance in the Plan, subject to the provisions of the Plan regarding directed investments. The Employee further understands that The University of Akron will not be responsible or liable for any loss or expense which may arise or result from compliance with any directions the Employee may give. The Employee acknowledges and agrees to be fully and completely responsible for ensuring that the amount of the contributions made under this Plan for any calendar year does not exceed the limitation on annual additions and the limitation on elective deferrals set forth in the Internal Revenue Code. The Employee further acknowledges and agrees that the University has the right to reduce the contributions elected if it is determined that the legal limit has been or will be reached and refund any excess deferrals or amounts. This designation shall remain in effect until such time as it is specifically revoked by filing a new form with the Plan. Employee Signature: Date:

 Return completed form to: Payroll Office +6210

Payroll Office Use ONLY (DO NOT PROCESS FORM UNLESS A SPECIFIC DOLLAR AMOUNT IS PROVIDED.) Entered by: Updated 12/21/17 Date Entered: