Page 13 - American Century Retirement Plan Enrollment Guide

4 Attention Married Participants: Election required (Continued):
Election to Waive Pre-Retirement Survivor Annuity
You may elect to waive this automatic form of payment, if your spouse agrees. If you complete this waiver, your spouse will receive your vested account balance as a lump sum distribution. Certain lump sum distributions are eligible for rollover or other special tax treatment. If you complete this waiver in Section 4, your spouse must sign in the Consent of Spouse in Section 5, and their signature must be notarized. Notaries are provided free of charge at all American Century Investor Center locations.
New Election Required at Age 35
Please note that if you waive this form of payment prior to age 35, under federal law, your election will become invalid at the start of the plan year in which you turn 35, and you will need to make a new election at that time.
You May Revoke This Waiver
You may revoke the waiver any time before your death. You may make a new election at any time in writing, with your spouse’s consent.
OR
Option A: Acknowledgment — No Waiver
By signing below, I acknowledge that I have been informed of the automatic pre-retirement survivor annuity. I do not wish to waive this automatic form of payment. I understand that if I die before the plan’s annuity starting date for benefits, the plan will automatically use the values of my death benefits to purchase a survivor annuity from an insurance company for my spouse.
// Signature Date (mm/dd/yyyy)
Option B: Election to Waive
I elect not to have my death benefit paid in the form of an automatic pre-retirement survivor annuity. My death benefit will be distributed in a lump sum payment to my spouse or other designated beneficiary after my death. Please note if you choose this option, you will need to have your spouse’s signature notarized.
// Signature Date (mm/dd/yyyy)
5*Consent of Spouse (Complete only if you mark C in section 3 and/or Option B: Election to Waive.)
I, the spouse of
certify that I have read this designation of beneficiaries and notice of pre-retirement survivor annuity. I hereby consent to the designations and acknowledge the effect — namely that they may modify, reduce or eliminate any benefits I may otherwise have received under the plan in the event of my spouse’s death. I further acknowledge that my consent to such designations and/or waivers is irrevocable unless my spouse files a new Designation of Beneficiaries and/or waiver form with the plan administrator.
Spouse’s Name (please print) Signature
Notary Acknowledgment (Required) State of
// Date (mm/dd/yyyy)
County of
On this day of
appears above, the spouse of the participant, to me personally known to be the person who executed the foregoing consent and acknowledged to me that (s)he executed the same as his or her own free act and deed and for the purpose therein stated.
//
Signature of Notary Public (Seal) Commission expiration date (mm/dd/yyyy)
there appeared before me in person, the person whose signature
Page 2 of 3