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Separation of Service Event Form

After processing, your Client Service Manager will e-mail you a Distribution Report containing the final distribution amount and information regarding payment processing/reimbursement receipt (if applicable).

Comments/Instruction

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My Balance

Total Balance

$14,583,581.77

Today's Date

January 1, 20YY

Plan Summary

$12,282,825.71

Account Balance

Demo Stability of Principal Fund

$3,080.00

30.8 %

*Hover over and click to change balances on the right
Name Units Balance
NameDemo Stability of Principal Fund Shares60.294 Balance$3,080.00
NameDemo Bond Fund A Shares45.929 Balance$2,110.00
NameDemo Bond Fund B Shares45.568 Balance$1,630.00
NameDemo Large Cap Value Fund A Shares26.9 Balance$1,760.00
NameDemo Small Cap Fund Shares5.97 Balance$920.00
NameDemo International Fund Shares4.794 Balance$460.00

Sources

Name % of Plan Vesting % Balance Vested Balance
Name20YY EE Deferral % of Plan60% Vesting %100.00 % Balance$6,000.00 Vested Balance$6,000.00
Name20YY Employer Match % of Plan20% Vesting %100.00 % Balance$2,000.00 Vested Balance$2,000.00
Name20YY EE Deferral % of Plan20% Vesting %100.00 % Balance$2,000.00 Vested Balance$2,000.00