Download QUALIFIED PLAN STATEMENT OF INVESTMENT DIRECTION FOR DOLLAR COST AVERAGING Account Number: _________________________

Account Number: _________________________
QUALIFIED PLAN
STATEMENT OF INVESTMENT DIRECTION
FOR DOLLAR COST AVERAGING
In order to meet the objectives of the
Plan & Trust, as established by
the Plan Trustee(s), Great Plains Trust Company (GPTC) is DIRECTED to invest Plan assets held under an Investment Management Agreement dated the
as set forth in this statement of investment direction. The investments to be used include the Collective Investment
day of
,
Funds for Retirement Pension and Profit Sharing Plans that are maintained by GPTC for qualified plans and "money market funds" utilized by GPTC. Trustee
(s) hereby warrants that this Statement of Investment Direction is consistent with Plan objectives and Trustee(s) is fully authorized to make determination of
Investment Direction. As a part of the initial investment allocation for the Plan, the Plan Trustee(s) directed that specific assets be maintained as part of the
initial allocation of Plan assets. The allocation of Plan investments with percentage of assets to be invested in each category are as follows:
CHECK ALL INVESTMENT CHANGES THAT APPLY:
THIS DEPOSIT ONLY in the amount of $
. Please invest $
GPTC's receipt of these instructions. These monthly investments shall: (Choose one)
Continue until entire deposit is invested at which time this direction will expire.
Continue for the next
months at which time this direction will expire.
on each Valuation Date immediately following
EXISTING ACCOUNT BALANCES on each Valuation Date immediately following GPTC's receipt of my instructions. Please redeem the funds
and amounts indicated by parenthesis $ (0.00) and buy the funds and amounts indicated without parenthesis $ 0.00. These monthly investments shall:
(Choose one)
Continue for the next _________ months at which time this direction will expire.
Continue until another Investment Direction For Dollar Cost Averaging is received which will automatically replace prior directions.
Discontinue all current monthly dollar cost averaging investment directions on the Valuation Date immediately following instructions.
ALLOCATIONS:
Great Plains Trust Company as Investment Manager and Custodian is directed to place all funds awaiting investment or distribution into a "money market" fund utilized
by GPTC for the temporary investment of Trust Funds. These totals will add to 100% of the Account other than maintained specific assets.
$
GPTC Equity Fund for Retirement, Pension & Profit Sharing
$
GPTC Fixed Income Fund for Retirement, Pension & Profit Sharing
$
GPTC Small Cap Fund for Retirement, Pension & Profit Sharing
$
GPTC U S A Global Fund for Retirement, Pension & Profit Sharing
$
GPTC Science & Technology Fund for Retirement, Pension & Profit Sharing
$
GPTC Midcap Fund for Retirement, Pension & Profit Sharing
$
GPTC Large Cap Fund for Retirement, Pension & Profit Sharing
$
GPTC International Fund for Retirement, Pension & Profit Sharing
$
Money Market Fund
KORNITZER CAPITAL MANAGEMENT, INC. AS INVESTMENT ADVISER
SIGNATURES:
THE COLLECTIVE FUNDS ARE VALUED ON THE LAST DAY OF EACH MONTH AND THEREFORE PURCHASE AND SALE TRANSACTIONS ARE
DONE ONLY ON THE LAST DAY OF EACH MONTH. IT IS UNDERSTOOD THAT INVESTMENT OBJECTIVES MUST BE REVIEWED PERIODICALLY
BY THE TRUSTEE(S) TO DETERMINE WHETHER CHANGES ARE REQUIRED TO MEET THE PLAN OBJECTIVES.
Trustee or Employer:
Trustee or Employer:
Trustee or Employer:
Trustee or Employer:
The above direction received by GPTC the
Authorized Officer
day of
,
.
Disclosure
An independent Advisor, Kornitzer Capital Management, Inc. (KCM), may be employed in connection with the management of the Common Trust Funds of Personal Trust of GPTC. Some
Shareholders of GPTC are employees of KCM. Some Shareholders of GPTC are family members of Shareholders of KCM. Some Shareholders of GPTC are neither employees of KCM., nor
family members of Shareholders of KCM.
Mail this form in triplicate to: Great Plains Trust Company, 7700 Shawnee Mission Pkwy Ste 101, Overland Park, KS, 66202.
This form should be received by noon on the last business day of the month. Faxed copies sent to 913-831-0007 will be accepted with originals following in the
mail. GPTC is not responsible for lost faxes.
YOU MUST VERIFY RECEIPT OF A FAX BY CALLING GPTC AT 1-888-529-2776.