Shubin Law Group - Web Book - Flipbook - Page 23
SHUBIN LAW GROUP 401(K) PLAN
Investment Election/Change Form
Shubin Law Group, P.A.
100 SE 2nd Street, Suite 4020
Miami, FL 33131
Certified Benefits Corp
1111 Douglas Avenue
Altamonte Springs, FL 32714
SECTION 1: Investment Option Election – this investment election will be applied to all contribution types.
You may select from the following list of Model Investment Portfolios, Target Date Funds or Mutual Funds.
□
Future Contributions
□
Existing account balance
Percentage to be
Allocated
_____.0%
Model Investment Portfolios
Ultra Conservative
□
Both Future and Current
Additional Investment Options:
Fidelity Nasdaq Composite Index - FNCMX
Percentage to
be Allocated
_____.0%
Conservative Growth
_____.0%
Fidelity Med Cap Index - FSMDX
_____.0%
Balanced Growth
_____.0%
Fidelity Large Cap Growth Idx - FSPGX
_____.0%
Moderate Growth
Max Growth
_____.0%
_____.0%
Target Date Funds
Vanguard Target Retirement Inc Inv - VTINX
Vanguard Target Retirement 2020 - VTWNX
Fidelity International Index - FSPSX
Fidelity Interm Trs Bd Index - FUAMX
Fidelity U.S. Bond Index - FXNAX
Fidelity Government MMkt - SPAXX
_____.0%
_____.0%
Schwab Total Stock Market Index - SWTSX
Vanguard Balanced Index Adm - VBIAX
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
Vanguard Target Retirement 2025 - VTTVX
_____.0%
Vanguard Emerg Mkt Stock Idx Adm - VEMAX
_____.0%
Vanguard Target Retirement 2030 - VTHRX
_____.0%
Vanguard Short-Term Inv Grade Adm - VFSUX
_____.0%
Vanguard Target Retirement 2035 - VTTHX
_____.0%
Vanguard Real Estate Index Admiral - VGSLX
_____.0%
Vanguard Target Retirement 2040 - VFORX
Vanguard Mid-Cap Value Idex Adm - VMVAX
_____.0%
Vanguard Target Retirement 2045 - VTIVX
_____.0%
_____.0%
Vanguard Pacific Stock Index Adm - VPADX
_____.0%
Vanguard Target Retirement 2050 - VFIFX
_____.0%
_____.0%
Vanguard Target Retirement 2055 - VFFVX
_____.0%
Vanguard Short-Term Treas Idx Adm - VSBSX
Vanguard Small Cap Value Idx Admi - VSIAX
Vanguard Target Retirement 2060 - VTTSX
_____.0%
Vanguard Small Cap Index Adm - VSMAX
_____.0%
Vanguard Target Retirement 2065 - VLXVX
_____.0%
Vanguard Shrt-Term Infl-Prot Sec Idx - VTAPX
_____.0%
Vanguard Target Retirement 2070 - VSVNX
_____.0%
Vanguard Total Wrld Stock Idx Adm - VTWAX
_____.0%
Vanguard Value Index Adm - VVIAX
_____.0%
Vanguard High-Yield Corporat Adm - VWEAX
_____.0%
_____.0%
TOTAL MUST EQUAL 100%
Automated Investment Strategies – (To be used only if more than one investment option is chosen.) Please choose
one of the following options (if no selection is made and more than one investment option is chosen above, the
account will be rebalanced annually). Please note that rebalancing will occur only if the initial allocation changes
by two percentage points or more.
❑ Do Not Rebalance
❑ Monthly
❑ Quarterly
❑ Semi-Annually
❑ Annually
SECTION 2: Signature – Review to make sure that you have completed each section fully. Please return this form
to your employer.
Employee Name (printed):______________________________________ SSN: ___________________________
Employee Signature: __________________________________________ Date: ___________________________
Employer Signature: __________________________________________ Date: ___________________________
Special 404 (c) Regulations Section and Notice of Limited Liability. This plan intends to comply with ERISA 404 (c) and Title 29 of CFR 2550.404 c-1.
Plan Fiduciaries may be relieved of liability for any losses that may result from participant’s investment instruction.
