Payroll Deduction Form


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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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