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Employee Profit-Sharing Plan Record
NAME_______________________________________________
¨ MALE ¨ SINGLE
ADDRESS____________________________________________________ ¨ FEMALE ¨ MARRIED
DATE OF
BIRTH_______________________________
DATE
ENTERED PLAN__________________________
AGE AT
ENTRY________________________________
DATE
EMPLOYED______________________________
NORMAL RETIREMENT DATE____________________
PARTICIPATION TERMINATION: DATE
___________________________________
¨RETIREMENT ¨
DEATH ¨
DISABILITY ¨ SEVERANCE ¨
OTHER
CHANGE OF ADDRESS:
DATE
|
NEW ADDRESS
|
DATE
|
NEW ADDRESS
|
BEBEFIFIARIES:
|
|||
NAME ADDRESS RELATIONSHIP DATE DESIGNATED
|
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SPECIAL NOTES:
|
EMPLOYEE’S PROFIT SHARING STOCK PLAN – FINAL STATEMENT
Nama___________________________ Social Security No.
________________
Date of
Termination_______________
Number of
shares Cash
Balance-as of_______________ ___________________ _______________
Your_______% vested interest ________ ________
Allowance for fractional share of
Stock @ $ __________per share, the
Market
value on ________________ ( ________ ) ( _________ )
Tax @ $
__________ per $ _______
Market value ____________ ____________
Final
distribution
________________ _____________
Consult your tax counsel regarding the manner in which this
distribution should on your tax returns.
Profit Sharing Plan Account Record
Date:___________________________________
EMPLOYEE’S NAME
|
ANNIVERSARY DATE
|
SHARE OF INCREASE
(DECREASE) IN VALUE OF FUND
|
ü
|
SHARE OF FORFEITURES
|
SHARE OF CONTRIBUTIONS
|
WITHDRAWALS
|
BALANCE
|
ü
|
PERCENT VESTING
|
VESTED INTEREST
|
ü
|
Job
Description
Name _______________________________________________________________________________
Departement_________________________________________________________________________
Plant oof office designation_____________________________________________________________
Job Title_____________________________________________________________________________
Superlor’s Name______________________________________________________________________
Superlor’s title________________________________________________________________________
PRIMARY PURPOSE OF JOB (summarize the role you play in
the company):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
BASIC JOB DUTIES (explain in detail your duties and
responsibilities):
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Signature______________________________________________ Date___________________________
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Reviewed by Kurnia jatnika
on
23.22
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