Institutional Investing Enrollment Form

Institution Information

Institution Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Day Phone(Required)

Fax(Required)

Employer Identification Number(Required)

Email Address(Required)

Authorized Representatives

The following representatives are authorized to make decisions on the institutional investment account and to request withdrawals on behalf of the institution.

Name(Required)

First Middle Last

Social Security Number(Required)

Phone Number(Required)

Email Address(Required)

Position(Required)

Name

First Middle Last

Social Security Number

Phone Number

Email Address

Position

Name

First Middle Last

Social Security Number

Phone Number

Email Address

Position

Name

First Middle Last

Social Security Number

Phone Number

Email Address

Position

Investment Selection

You may invest in one or all investment options. Please indicate the percentage that you want invested in each option (must total 100%). If no choice is made, all funds will remain in the Default Strategy.

Investment Options (See Investment Plan Options for a description)

The Set Rate Fund*

The Moderate Strategy*

The Default Strategy*

The Maximum Strategy*

All Cap Growth Equity

Large Cap Growth

Large Cap Value

SMID Cap

Real Estate (REITs)

Intermediate Fixed Income

Short Term Fixed Income

Total

Total should amount to 100%.

* Preset Plan with set allocations (For more information about Preset Plans, see Investment Plan Options)

Certification

The institution requests that the Board of Retirement invest our accumulations/contributions based upon our investment choices above. The institution has reviewed the information provided by the Board of Retirement and has made this selection based upon our own investment judgment. The institution also realizes that past results are not a guarantee of future performance.

Todays Date(Required)

Signature(Required)

Use your mouse (or finger if on a mobile device) to sign your name in the box below.

Referral

If you were referred to the Board of Retirement or heard about us at an event, please let us know in the box below.

Referral