STATE AUTO FINANCIAL CORPORATION SUPPLEMENTAL EXECUTIVE RETIREMENT PLANEmployee Benefits Plan Agreement |
|
|
|
You are currently viewing: This Employee Benefits Plan Agreement involves
State Auto Financial Corporation. RealDealDocs™ contains millions of easily searchable legal documents and clauses from top law firms. Search for free - click here. |
|
|
|
Search Employee Benefits Plan Agreement by:
Exhibit 10.73
STATE AUTO FINANCIAL CORPORATION
SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN
DISTRIBUTION ELECTION FORM
This form is an election form governing benefit distributions from the State Auto Financial Corporation Supplemental Executive Retirement Plan (the “SERP”). Capitalized terms, if not defined herein, are as defined in the SERP document.
Please complete the following:
Name: __________________________________________________________________________________________________
Soc. Sec. No.: ______________________________________________ Date of Birth: __________________________________
Address: _________________________________________________________________________________________________
_________________________________________________________________________________________________________
ELECTION INSTRUCTIONS
Select a time and form of distribution for your SERP benefits. Also select a form of distribution for any death or disability benefits payable from the SERP. Complete the Beneficiary Designation portion of the form.
|
A. |
TIME AND FORM OF PAYMENT OF SERP BENEFITS |
Complete this payment election section to indicate the time and form of payment of your SERP benefits.
NOTE: Changes to the form and/or time of payment after an initial election will be effective for all benefits payable to you under the SERP (not including death or disability benefits) AND will require a delay in the timing of your payment(s) (as described below).
|
This is (check one): |
¨ an initial election |
|||
|
¨ a modified election |
(I understand that my payments will be delayed as required by law as described below***) |
|
[1] |
TIME OF PAYMENT |
I elect payment of my SERP benefits to commence as of my Separation from Service 1 with the Company and: ( select one )
|
¨ |
my attainment of age ___, ( any age other than 65 ) |
|
¨ |
my attainment of age 65, or |
|
¨ |
__________________________________ ( Insert a specific date for a later payment of your SERP benefits. ) |
|
[2] |
FORM OF PAYMENT |
|
1 |
If you are a “specified employee” as defined in Section 409A of the Internal Revenue Code of 1986, as amended, payment of your SERP benefits will be delayed for a period of at least six months after the date of your Separation from Service, as required by Code Section 409A. |
I elect payment of my SERP benefits as: ( select one )
|
¨ |
monthly installment payments for a period 120 months, as calculated under the SERP, |
|
¨ |
a joint and survivor annuity with a 50% annuity benefit paid to my beneficiary, |
|
¨ |
a joint and survivor annuity with a 100% annuity benefit paid to my beneficiary, |
|
¨ |
a single life annuity, or |
|
¨ |
a lump sum payment. |
NOTE: If you make no election under the Form of Payment, the automatic form of payment (a single life annuity payable upon Separation of Service and attainment of age 65) under the SERP will apply.
***IMPORTANT INFORMATION ABOUT CHANGES TO PAYMENT TIMING AND FORM***
I F YOU ELECT TO CHANGE THE FORM OR TIMING






