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EXHIBIT 4.3
LORAIN NATIONAL BANK
401(K) RETIREMENT PLAN
ENROLLMENT FORM AND SALARY SAVINGS AGREEMENT
SS Number _____-___-______
Name: ___________________________________________ Date of Birth: ___/___/___
Address: ________________________________________ Date of Hire: ___/___/___
________________________________________
City: __________________________ State: ______________ Zip Code: __________
[ ] Check here to only correct or change the above information.
AUTOMATIC PARTICIPATION NOTICE
I am aware that upon my employment to Lorain National Bank, I am automatically
enrolled as a participant in the Bancorp (401(k) Retirement Plan and
automatically 3% of my compensation will be deferred.
3% of My Compensation From Each Pay
[ ] I DO NOT WISH to take advantage of this opportunity to become a
Participant in Lorain National Bank 401(k) Retirement Plan at this
time. I understand that I may change this election later by filing
a new copy of this form.
I AM CURRENTLY A PARTICIPANT
As a participant, I AUTHORIZE Lorain National Bank TO CHANGE the amount
it deducts from my Compensation from
_________% of My Compensation To __________% of My Compensation
I understand that this change will be effective on the first date of
the next valuation date.
[ ] I WITHDRAW MY AUTHORIZATION TO CONTINUE payroll deductions under
the Lorain National Bank 401(k) Retirement Plan. I understand this
will be effective 30 days from delivery of this notice to Lorain
National Bank. I further understand that I may again authorize
payroll deductions if I file a new copy of this form.
Signed: _________________________________________ Date: _______________
Participant
Signed: _________________________________________ Date: _______________
On Behalf Of The Plan
