Valero 2015 Annual Report Download - page 162
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 |
 |
In accordance with Section 6.4 of the Plan, I hereby elect to receive in one lump sum payment my Account derived from deferrals
made during the on the date or dates specified below, or the balance of the Account, if less. Any amounts distributed
pursuant to this election shall immediately reduce my Account accordingly. (The earliest date that can be elected to receive 2016
deferrals is January 1, 2020.)
Amount of Elective Deferral or
Specified Date Total Amount of the Account (Whichever is Less)
___________________ ________________________
___________________ ________________________
___________________ ________________________
In order to be effective, this form must be completed, signed, and returned to Financial Benefits (San Antonio/Mailstation E1L)
on or before . If your form is not timely submitted, your Plan deferral will be subject to the default distributions
noted above.
The Company has taken measures to design the Plan in a manner that conforms to current tax law. However, it is possible that new legislation could affect your distribution
elections, including delaying your distributions, in order to comply with legal requirements. Distribution elections submitted pursuant to the Plan will be governed by the terms and
conditions of the Plan and governing law, and your elections will be subject to modifications made to the Plan in order to conform to legal requirements.
ACKNOWLEDGED AND AGREED:
Participant’s Signature
Date
Participant’s Name
Participant’s Employee ID Number