Optio
onal Retire
ement Plan (ORP) V
Vendor Sele
ection Form
m
Mo
organ Statte Universiity (MSU)
In order to enroll in
n the Option
nal Retireme
ent Plan and
d select the ORP Vendoor of my chooice
I,
, SS
SN
(First Na
ame
Middle Initial
,
Last Name)
have attached an “E
Election Nott to Particip
pate in the M
MD State Peension Systeem” form
60), and the
e required proof of identity (see rev
verse side).
(MSRA-6
I select the follow
wing vendor and actio
on: (Please select one veendor and on
ne action)
VENDO
OR:

Y INVESTM
MENTS
FIDELITY
 T
TIAA-CREF
F
ACTION
N:

Enroll
 C
Change
I recogniize that the University will contrib
bute an amoount equal tto 7.25% of my base annual
salary to
o the ORP on my behalff. I understtand that U
University coontributionss will be ma
ade
over 20 pays
p
during
g the academ
mic year, an
nd invested u
upon enrollment in a “L
LifeCycle
Fund.” After
A
enrollment is in effect,
e
I can access the O
ORP Vendoor website an
nd, at my
direction
n, designate my investm
ment among
g the funds a
available foor the MSU--ORP. No
money will
w be deduccted from my
m salary. I reserve thee right to ma
ake volunta
ary
contributions on a salary
s
reducction (before
e tax) basis tto a Supplemental Retirement Pla
an,
t Federal liimits.
subject to
S ON CONT
TRIBUTIONS: I recog
gnize that iff I was hired
d on or afterr July 1, 1996,
LIMITS
the Univ
versity’s 7.25% contribu
ution to my ORP will sttop once my
y earned salary in the fi
fiscal
year reaches the Federal limit on employerr contributiions to the O
ORP.
REHIRE
ES: I underrstand that if I am rehiired and I w
was an ORP
P participantt in MD beffore
July 1, 1996,
1
the Fe
ederal contriibution limiit does not a
apply to me and I am en
ntitled to ha
ave
the 7.25%
% contributtion applied to my full salary.
s
My prior MSU or other MD
D institution
n of
higher education da
ates of employment are:
Hired:
My initial MD-ORP partticipation date
e was:
Termin
nated:
Ins titution:
rstand:  the conditioons stated a
above;  tha
at I may enroll
By signing this form I under
y one ORP Vendor
V
at any
a given tim
me;  that I am entitleed to changee ORP Vend
dors
with only
only once
e during an
ny calendar year;
y
and  I will keep
p a copy of th
his documen
nt for my filles.
Employee
e’s Signature
e:
Date:
MSU Ben
nefits Coordin
nator:
Date:
(Institution Representative)
R
Office Ph
hone:
HR49 (0
01/11) VALID TYPES OF IDENTIFICATION
New employees must provide proof of identity when making application for enrollment in
the Optional Retirement Plans. Copies of the following documents are acceptable as proof
of identity. Please attach two Xerox copies of the documents you are submitting as
identification to your Optional Retirement Plan application forms. Make sure that the
copies of the documents can be clearly read.
Provide one of the following documents:
OR Provide two of the following documents:
Birth Certificate
Affidavit of Parent
Birth Certificate of Child
Census Record
Church or Sunday School Record
Club or Lodge Record
Confirmation Record
Diary
Driver’s License
Election Registration
Employment Record
Family Doctor’s Record
Fraternal Organization Record
Hospital Record
Immigration Registration or Visa
Marriage Record
Military Identification or Service Card
Professional Organization Record
School Report Card
Selective Service Registration
Statement of Physician or Midwife
present at Birth
Vaccination Record
Passport
Naturalization Record
Military Discharge Papers
School or College Record (if at least five
years old)
Life Insurance Policy (if at least five
years old)
Baptismal Certificate
Family Bible – copy of page
(Will only be accepted if accompanied by a
statement, from a Plan Representative in
your Institution’s Benefit Office or a Notary
Public, that provides the following
information:  she/he has examined the
Bible;  gives the name of the individual
that made the entry in the Bible;  the date
the entry was made; and  that your name
and date was shown in the entry.)
HR49 (01/11)