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Payroll Deduction Form PO Box 55932 • Boston, MA 02205-5932 • 800-525-3713
You may invest in your existing Janus account(s) with a deduction taken directly from your paycheck. Use this form to begin a new Payroll Deduction plan or to make changes to an existing Payroll Deduction plan. Complete this form, attach a copy of your most recent Janus statement to ensure proper credit to your account, and return it to
your Payroll Office. If you are a federal government employee or making a deposit from a social security check, you must fill out and return
Form 1199A. Please print or type in black ink. Questions? Call 800-525-3713.
Important: For Employee’s Payroll Office – Do Not Return to Janus
1. What name is on your account?
First Name
Middle Initial
Street Number
Street Name
Apartment Number
City
State
Zip Code
Social Security Number (required)
Last Name
Preferred Phone Number
2. What is your Janus account number?
Account Number
(Do not include the two-digit fund number preceding the account number.)
□
Check here if this is a retirement account.
Contributions made through payroll deduction will be applied as contributions for the year in which the shares are purchased.
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3. Which fund(s) would you like to contribute to? Please indicate existing fund(s) in which you wish to make a Payroll Deduction plan investment. Global & International
Asset Allocation Janus Balanced (51)
$ ________________
Janus Adaptive Global Allocation (44)
$ ________________
Janus Global Allocation—Growth (76)
$ ________________
Janus Asia Equity (83)
$ ________________
Janus Global Allocation—Moderate (77)
$ ________________
Janus Emerging Markets (79)
$ ________________
Janus Global Life Sciences (59)
$ ________________
Janus Global Real Estate (31)
$ ________________
Janus Global Research (41)
$ ________________
Janus Global Allocation—Conservative (78) $ ________________
Growth & Core Janus Contrarian (61)
$ ________________
Janus Global Select (62)
$ ________________
Janus Enterprise (50)
$ ________________
Janus Global Technology (60)
$ ________________
Janus Fund (42)
$ ________________
Janus International Equity (28)
$ ________________
Janus Growth & Income (40)
$ ________________
Janus Overseas (54)
$ ________________
Janus Research (48)
$ ________________
Janus Triton* (74)
$ ________________
Mathematical
Janus Twenty* (43)
$ ________________
Janus Venture* (45)
$ ________________
INTECH Emerging Markets Managed Volatility (32)
$ ________________
INTECH Global Income Managed Volatility (84)
$ ________________
INTECH International Managed Volatility (30)
$ ________________
INTECH U.S. Core * (70)
$ ________________
INTECH U.S. Managed Volatility (26)
$ ________________
Value Perkins Global Value (64)
$ ________________
Perkins International Value (88)
$ ________________
Perkins Large Cap Value (35)
$ ________________
Perkins Mid Cap Value* (67)
$ ________________
Perkins Select Value (85)
$ ________________
Fixed Income (Bond)
Perkins Small Cap Value (65)
$ ________________
Janus Flexible Bond (49)
$ ________________
Perkins Value Plus Income (36)
$ ________________
Janus Global Bond (80)
$ ________________
Janus High-Yield (57)
$ ________________
Janus Multi-Sector Income (89)
$ ________________
Alternative Janus Diversified Alternatives (87)
$ ________________
Janus Real Return (82)
$ ________________
Janus Global Unconstrained Bond (90)
$ ________________
Janus Short-Term Bond (52)
$ ________________
Money Market Janus Government Money Market (38)
$ ________________
Janus Money Market (37)
$ ________________
*Closed to new investors.
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4. Before you give this completed Payroll Deduction Form to your payroll office, please sign here. I hereby authorize my employer to make periodic investments to my Janus account(s) in the amount specified for each pay period: Total Investment Amount (per pay period) $ ______________
Signature of Owner, Trustee or Custodian
Date
To be completed by Employee’s Payroll office Please retain this form to document the employee’s authorization for this Payroll Deduction plan. For ACH purposes, code this as a checking account. The transit routing number is 10200007-6. For State Street Bank and Trust Company Retirement accounts, the ACH number is 15090 + the two-digit fund number + 0 + the employee’s Janus account number. Example: If the employee has Janus Contrarian, Retirement account #12345, the 17 digit number should be entered as 15090610000012345. For all other accounts, the ACH account number is 14890 + the two-digit fund number + 0 + the employee’s Janus account number. Example: If the employee has Janus Contrarian, Non-Retirement account #12345, the 17 digit number should be entered as 14890610000012345.
Retirement Accounts: ACH Account Number
Fund Number
Janus Account Number
ACH Account Number
Fund Number
Janus Account Number
ACH Account Number
Fund Number
Janus Account Number
ACH Account Number
Fund Number
Janus Account Number
ACH Account Number
Fund Number
Janus Account Number
ACH Account Number
Fund Number
Janus Account Number
Non-Retirement Accounts:
296-11-01653 10-15
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