San Diego and Imperial County Employer Forms

FBC / Nationwide Plan Forms

These forms are used to create or make changes to your Fringe Benefits Consortium / Nationwide plan account.  Select and print the form that applies to your situation.

Complete Enrollment Packet

   FBC Nationwide Enrollment Form

   FBC Salary Reduction Agreement

   2008 Maximum Contribution Worksheet

   2009 Maximum Contribution Worksheet

   FBC Transfer In / Rollover In Request Form

Beneficiary Designation Form

Meeder MAP+ Application

Change of Address Form                     

Withdrawal Authorization Forms (Other Vendor Plan Forms)

Withdrawal transaction (distribution/rollover, hardship withdrawal, or loan) from a non-Nationwide 403(b) plan provider require that you complete your provider's withdrawal forms as well as a corresponding authorization form provided below.  These authorization forms are required by your employer to assist in monitoring your account for compliance with IRS rules and limits.  Your 403(b) provider should not process a withdrawal transaction for your account without a completed Authorization Form.

          FBC 403(b) Distribution/Rollover Authorization Form

          FBC 403(b) Exchange Authorization Form

          FBC 403(b) Hardship Authorization Form

          FBC 403(b) Loan Authorization Form

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