SEP Plan Declaration Form
Please complete this SEP Plan Declaration Form to confirm your participation or eligibility status. All information will be used solely for SEP plan administration and will remain confidential.
Employee Full Name
*
First Name
Last Name
Employee Email Address
*
example@example.com
Department
Job Title
Date of Hire
-
Month
-
Day
Year
Date
Last 4 Digits of Employee ID
*
Are you currently participating in the SEP plan?
*
Yes
No
If not participating, are you eligible for SEP plan participation?
*
Yes, I am eligible
No, I am not eligible
Comments or Additional Information (optional)
Employee Signature
*
Date of Declaration
*
-
Month
-
Day
Year
Date
Submit Declaration
Submit Declaration
Should be Empty: