EX-4.3 2 k59406ex4-3.txt ENROLLMENT FORM FOR LORAIN NATIONAL BANK EMPLOYEES 1 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