*To enroll in the BCN 401(k) plan sponsored by your worksite employer, please complete the following form (2 pages):

Type the information on the form or print and fill out,

then mail or fax the completed form to:

Slavic Integrated Administration

Attention: New Plans Department

1075 Broken Sound Parkway NW, Suite 100

Boca Raton, Florida 33487-3540

Fax: (561) 241-1070

Before investing, you should determine your risk tolerance. Take this short

Risk Profile Test

to see what type of investments you should make.

*NOTE: Please check your worksite employer’s Summary of Benefits to determine eligibility requirements. Enrollment is effective on the first of the month after meeting your worksite employer’s eligibility requirements.

If you have any questions regarding this form, please call Slavic Investment Group’s customer service center at

(800) 356-3009.

Forms online are available to you in the Adobe Acrobat Portable Document Format (.pdf). Adobe Acrobat files are universally available – whether you’re using a Windows, DOS, Macintosh or Unix system, you can view and print the file using the free Acrobat Reader. In order to access these or any other Adobe Acrobat file available online, you will need to Get Acrobat if it is not yet installed on your computer’s hard drive. Copying the Acrobat Reader should take no more than a few minutes. Once it’s installed on your hard-drive, you will be able to click on all Adobe Acrobat files and easily view or print.