Jay Hauke.Draftline Enrollment - Web Book - 2025 - Flipbook - Page 22
Jay Hauke Payroll Incorporated 401(k) Plan
Enrollment / Information Change Form
Certified Benefits Corp
1111 Douglas Avenue
Altamonte Springs, FL 32714
Jay Hauke Payroll Incorporated
400 N. New York Ave., Suite 208
Winter Park, FL 32789
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
□ Both Future and Current
Model Investment Portfolios
Conservative
Percentage to be
Allocated
_____.0%
Additional Investment Options:
American Century Sm Cap Growth - ANODX
Percentage to
be Allocated
_____.0%
Moderately Conservative
Moderate
Moderately Aggressive
_____.0%
_____.0%
_____.0%
AB Large Cap Growth Z - APGZX
Cohen & Steers Instl Realty Shares - CSRIX
DFA International Small Company I - DFISX
_____.0%
_____.0%
_____.0%
Aggressive
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
_____.0%
Vanguard Target Retirement Inc Inv - VTINX
Vanguard Target Retirement 2020 - VTWNX
Vanguard Target Retirement 2025 - VTTVX
_____.0%
_____.0%
_____.0%
Dodge & Cox Global Bond Fund- DODLX
Fidelity Advisor Intl Capital App Z - FIDZX
Fidelity Advisor® Intl Sm Cap Opps Z -FIQJX
Fidelity 500 Idx Institutional Prem - FXAIX
JPMorgan Mid Cap Growth Fund - JMGMX
Prudential High-Yield Q - PHYQX
PIMCO Income Instl - PIMIX
Vanguard Target Retirement 2030 - VTHRX
_____.0%
Invesco Stable Value Trust-Class I - QJQKQ
_____.0%
Vanguard Target Retirement 2035 - VTTHX
_____.0%
American Funds Bond Fund Amer R6 - RBFGX
_____.0%
Vanguard Target Retirement 2040 - VFORX
_____.0%
American Funds New Persp R6 - RNPGX
_____.0%
Vanguard Target Retirement 2045 - VTIVX
_____.0%
Schwab Fdmtl Intl Lg Co Idx - SFNNX
_____.0%
Vanguard Target Retirement 2050 - VFIFX
_____.0%
Vanguard Equity Income Admiral - VEIRX
_____.0%
Vanguard Target Retirement 2055 - VFFVX
_____.0%
Vanguard Fed Money Market Invest - VMFXX
_____.0%
Vanguard Target Retirement 2060 - VTTSX
_____.0%
Vanguard Materials Index Admiral - VMIAX
_____.0%
Vanguard Target Retirement 2065 - VLXVX
_____.0%
Vanguard Shrt-Trm Treasury Indx Fnd - VSBSX
_____.0%
Vanguard Target Retirement 2070 - VSVNX
_____.0%
Vanguard Small Cap Value Idx Adm - VSIAX
_____.0%
Allspring Special Mid Cap Value R6 - WFPRX
_____.0%
Target Date Funds
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. - Funds as of 9.15.24
