Nomination Form for the 2023 401(k) Champion® Award Sponsored by Jackson, Grant Investment Advisers, Inc.

Nomination Deadline: Thursday, December 7, 2023 11:59 P.M. EDT

The 401(k) Champion® Award is the first award of its kind to shine a light on employees who live financially literate lives by optimizing their 401(k)s. We seek your help in nominating a friend or colleague to compete for the award.

To nominate someone else, please submit this nomination form in its entirety before the deadline (no later than Thursday, December 7, 2023 11:59 P.M. EDT). Those you nominate will be asked to complete an application and to confirm that they are participating in their 401(k)s at work.

Three award-winners will be announced Monday, January 8, 2024. Each will be awarded a cash prize of $1,000.

To be eligible to be considered, nominees must be 21 or over, be legal residents of the 50 United States or the District of Columbia, and be currently participating in their employer’s 401(k) plan (not a 403(b) plan or other type of plan). Employees of the sponsor and certain other individuals are not eligible. A full set of rules is posted on www.401kChampion.com/rules.

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* 1. I am nominating the following person. (We will email the award application link to the nominee.)

First Name *

Last Name

City/Town

State/Province

ZIP/Postal Code

Email Address *

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* 2. What is your relationship to your nominee?

The nominee works for me

The nominee is a co-worker

The nominee is a family member

The nominee is a friend

Other

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* 3. How did you hear about the 401(k) Champion® Award? Please be as specific as possible.

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* 4. Please provide your contact information

First Name

Last Name

State/Province

ZIP/Postal Code

Email Address