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 ($46000 in 2024) 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.

*Employer Name: *Date of Hire: (MM/DD/YYYY)
Oxnard Union High School District

Participant Information:

*Last Name:    *First Name:    MI: 
Maiden/Former Name:   
* Phone Alternate Phone
* Email * Re-enter Email:
*SS#: (9 digits, no dashes or spaces) * Date of Birth: (MM/DD/YYYY)

  I am a police officer or firefighter.

  I have previously contributed amounts in excess of my age-based contribution limit under the auspices of the final three year catch-up provision.

  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.

If permitted by my Plan, I wish to designate my normal retirement age as:

By clicking the button below labeled "Continue", I hereby request that Tax Deferred Solutions calculate my eligibility for the Final Three Year Catch-Up provision, and update my Maximum Allowable Contribution (MAC) based upon the outcome of such calculation(s). I acknowledge that my designation of normal retirement age is irrevocable if and when deferrals allowed by the Final Three Year Catch-Up are made. I further understand that my MAC will revert to the age-based limit at the close of the current calendar year, and, therefore, I will be required to resubmit this form and any requested information and/or documentation in order to utilize the Final Three Year Catch-Up in subsequent years. I further acknowledge that determination of my eligibility for this catch-up provision may be contingent upon my ability to supply Tax Deferred Solutions with historical information and documentation concerning my prior contributions to my retirement plan(s), and agree to furnish such information and/or documentation upon request.

*Re-enter Social Security # to verify:

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