457 FINAL THREE YEAR CATCH-UP REQUEST FORM
Step 1 of 3: Supply Information | Step 2 of 3: Confirm Entries | Step 3 of 3: Submission Confirmation
- Please supply the information requested below.
- Read all agreements on this form before submitting.
- Fields having an asterisk notation are required.
Your employer's 457 plan permits eligible participants to utilize the Final Three Year Catch-Up. This catch-up permits employees to contribute up to twice the base limit ($47000 in 2025) in the three year
period prior to the year in which the participant reaches the normal retirement age as defined by the plan.
457 Plan Sponsor:
Please provide the information for the employer with whom you'd like to utilize Final Three Year Catch-Up.
Participant Information:
*Last Name:
*First Name:
MI:
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Maiden/Former Name:
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*
Phone
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Alternate Phone
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*
Email
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*
Re-enter Email:
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*SS#:
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(9 digits, no dashes or spaces)
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*
Date of Birth:
(MM/DD/YYYY)
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I am a police officer or firefighter.
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I have previously contributed amounts in excess of my age-based contribution limit under the auspices of the final three year catch-up provision.
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Between January 1, 1979 and December 31, 2001, I have previously contributed to a 403(b), 457, 401(k), 402(h)(1)(B) simplified employee pension (i.e., SARSEP), 408(p) simple retirement plan (i.e., simple IRA), or any other plan in which a deduction was allowed at another employer.
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If permitted by my Plan, I wish to designate my normal retirement age as:
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