___________%

- -

Generally, Mark 100% In Only One Fund

Balanced 

Small Cap Stock 

International

Large Cap Stock Growth

Large Cap Stock Index

Large Cap Stock Value 

Cancel future deferrals from my salary.

___________%

Bond 

Income 

___________%

___________%

Long Horizon Fund

Medium Horizon Fund

___________%

I am leaving employment and wish to have $ _____________ deferred from my final paycheck. Date of final paycheck _____________ 

Total amount to be withheld per pay period $ ____________ or ____________ % beginning the next possible pay period. 

401(k) or 457 PLAN

INVESTMENT CONTRACT 

be returned to you.

___________%

be returned to you.

The total of the percentage(s) in both columns combined must equal 100%. If the total does not equal 100%, the form will

IMPORTANT: 

___________%

___________%

___________%

___________%

___________%

___________%

___________%

___________%

___________%

___________%

___________%

___________%

Transfers to current account balances can occur only every 30 days without incurring short-term trading fees. See reverse for details.

No Change 

Asset Allocation Funds 

Individual Funds

Generally, Mark 100% In Only One Fund

Short Horizon Fund

___________%

Mailing Address Daytime Phone Number

Fax 801-366-7445 or 800-753-7445 

www.urs.org

INSTRUCTIONS: 

1. Use this form to select how your existing Utah Retirement Systems (URS) 401(k) or 457 Plan is invested. 

2. Review both sides of this form before completing. 

3. Please type or print clearly in black ink. 

4. If you fax this form, do not mail the original.

SECTION A - GENERAL INFORMATION

801-366-7720 or 800-688-4015 

City State Zip Employer 

SECTION B - PLAN SELECTION

SECTION C - FUTURE DEFERRALS FROM MY SALARY

Changes in deferrals to the 457 Plan cannot begin until the 

Salt Lake City, Utah 84110-1590 

PO Box 1590 

Utah Retirement Systems 

457 Plan

or 

401(k) Plan 

Check Only One 

(See reverse side for a description of the different Investment Funds.)

SECTION D - INVESTMENT OF FUTURE VESTED DEPOSITS 

Name (First, Middle, Last) Birth Date (mm/dd/yyyy) Social Security Number

Asset Allocation Funds 

Individual Funds

The total of the percentage(s) in both columns combined must equal 100%. If the total does not equal 100%, the form will

IMPORTANT: 

Small Cap Stock 

International

Large Cap Stock Growth

Large Cap Stock Index

Large Cap Stock Value 

Balanced 

Bond 

Income 

___________%

Long Horizon Fund

___________%

Medium Horizon Fund

___________%

Short Horizon Fund

Use this section to change how your future deposits are invested. This may be changed daily and will not affect your current account.

No Change 

DCCT-2 Rev 6/29/2011

SECTION F - SIGNATURE Date

SECTION E - TRANSFER CURRENT VESTED ACCOUNT BALANCE

calendar month following the date this form is signed.

5% 

11% 

16% 

Large Cap Stock Value Fund 

4% 

6% 

6% 

International Bonds 

10% 

5% 

9%

International Fund 

10% 

18% 

28%

Large Cap Stock Growth Fund 

4% 

6% 

6%

Large Cap Stock Index Fund 

0% 

Long Horizon 

Fund

** For additional information refer to the Fund Fact Sheets at www.urs.org.

30% 

10% 

5% 

Bond Fund 

35% 

15% 

Income Fund 

15% 

0% 

Large Cap Stock Value Fund : stocks that appear to be undervalued, with a favorable future outlook. 

transferred using that evening’s closing market values. Change requests received after the close of the NYSE will be transferred using the next 

business day’s closing market values. On days of unusually heavy transfer activity, computer system failure or other unforeseen circumstances, 

URS reserves the right to process transfers using the next available business day’s closing market values. Elections for the investment allocation 

of future vested deposits and the elections of future vested deferral amounts will be allowed as often as daily. 

Individual Funds - 

You can design your own portfolio using the eight URS individual investment options. Each investment option represents different investment 

objectives, styles, and risk/return characteristics. The options are:

Income Fund : a stable value fund; the most conservative of the investment options. 

Bond Fund : fixed income securities, such as corporate and government bonds. 

Balanced Fund : approximately 60% stocks, and 40% bonds. 

Investment instructions received at URS before the close of the New York Stock Exchange (NYSE), generally 2:00 PM Mountain Time, will be 

Large Cap Stock Index Fund : stocks that comprise the Russell 1000 index. 

Large Cap Stock Growth Fund : stocks that have above average earnings growth potential. 

International Fund : stocks of companies based outside the United States. 

Small Cap Stock Fund : stocks of companies whose market capitalization falls primarily within the smallest 10% of the market universe.

Inflation-Protected Securities 

10% 

* The Medium Horizon Fund is the default fund when no investment election for future deposits has been selected, and for any Tier 2 unvested funds.

Additional information and account access is available at www.urs.org, the URS offices or by calling 801-366-7720 or 800-688-4015.

Asset Allocation Funds - 

The Horizon Funds are portfolios comprised of the URS Individual Investment Options. The allocation mix for each fund is based on the length 

of time until you withdraw the funds and your tolerance for risk. These funds are rebalanced quarterly when target ranges are exceeded.

Short Horizon : a conservative portfolio designed for investors with an investment horizon of approximately 5 years. 

Medium Horizon* : a moderate portfolio designed for investors with an investment horizon of approximately 5 to 10 years. 

Long Horizon : an aggressive portfolio designed for investors with an investment horizon of more than 10 years.

5% 

DCCT-2 Rev 6/29/2011

DESCRIPTION OF INVESTMENT OPTIONS

TRANSFER POLICIES

Core Fund Transfer Policy 

Participants are allowed to submit one transfer request (whether electronically, by fax, mail or hand delivered) for their current vested account 

balances every seven (7) days. This applies separately to each plan in which they participate - the 401(k), 457, Roth IRA and Traditional IRA each 

constituting a separate plan. In addition, individuals who transfer any or all of their current vested account between core investment options more 

often than once every 30 days will be charged a 2% short-term trading fee on amounts transferred. Each transfer, after being processed, will 

start a new 30-day period. 

Additional Information Regarding Transfers 

Commodities 

3% 

5% 

7%

Real Estate Investment Trusts 

0% 

4% 

8%

Small Cap Stock Fund 

4% 

0% 

Medium Horizon 

Fund 

Short Horizon 

Fund 

Horizon Fund asset classes**: 

Total 

100% 

100% 

100%