Salary Reduction Agreement For The Bethel 403(b) Plan
Fillable Salary Reduction Agreement
By entering your information into the fillable form below, and then clicking the 'Generate Printable SRA Form' button, you will generate a printable Salary Reduction Form which should be printed out, signed by you, and then submitted to Bethel
with documentation that you have established an account with each selected Vendor:
Your Name, Address, and Contact information is required.
Implementation: This Salary Reduction Agreement (the 'Agreement') supersedes any previous Salary Reduction Agreement for the person named below (the "Employee") under the 403(b) Tax Sheltered Annuity Plan (the "Plan") offered by School District No. 52, Lane County, Oregon (the "Employer"), also known as Bethel School District. The salary reduction specified in this agreement will begin with the first paycheck on or after the "Effective Begin Date" specified below, provided this form is received by the Employer before the Payroll cutoff date for that paycheck. This Agreement will remain effective until a new Agreement is submitted.
Select the Appropriate Type of Agreement Below:
Distribution Among Vendors
If selecting a new Vendor, you MUST include documentation that an account has been established with the new Vendor that is linked to Bethel. Vendor accounts linked to former employers may not be used for contributions at Bethel. Bethel allows you to contribute to a maximum of 3 different vendors. If Replacing/Overriding a Previous Salary Reduction Agreement or Starting/Initiating a New Salary Reduction Agreement, you must select at least one Vendor.
Finally, if this is one of 5 forms to be submitted as a group to establish an Active Payroll Slot for a new Vendor, then select "Other" from the pull-down box and write in the Vendor Name on the printed version of the form (all 5 forms should be submitted to CCC).
Clicking the button below will Generate a printable PDF form populated with the information entered above. You must still sign, date, and submit the form to