Raare Solutions, LLC Enrollment Form

Name *
Address *
Marital Status
You must pick from one of the following
Deferral Election
Below, select if you'd prefer to have your contribution based on either [a] a per pay period % or dollar amount or; [b] an annual amount in dollars
Note: Your annual amount if expressed in this will be divided ratably across your payroll for the year.
Catch Up Contributions
This catch up contribution is:
Please let us know if you qualify and want to increase your contribution at the outset of this enrollment to provide for "over age 55" catch up contributions
Beneficiary Information
Please provide us with [a] a primary beneficiary and; if applicable; [b] a secondary beneficiary in case your primary beneficiary is not alive at the time of your death. Please list the full Name, Address and Social Security Number for each beneficiary. If more than one beneficiary is designated in a Class; payments will be made in equal shares to (only) those who survive the participant.
Name *
Address 1 *
Address 1
Tell us what percentage of your benefit that this beneficiary would receive in the event of your death
Name 2 *
Name 2
Address 2 *
Address 2
If this beneficiary is to receive a share of your benefit in the event of your death (in addition to the Primary beneficiary) please tell us that amount here. (As an example, if your brother and sister were both to receive a share of your account in the event of your death then your brother might receive 50% and your sister would receive 50% as well.
Enrollment Agreement
I Agree and Submit my form.... *
By checking the box and selecting to submit this form you are stating that you are in agreement with the sections of this form as submitted and fully understand the implications of this submission.