EX-10.16 FORM OF DEFFERED COMPENSATION AGREEMENT

EX-10.16 3 l12603aexv10w16.txt EX-10.16 FORM OF DEFFERED COMPENSATION AGREEMENT EXHIBIT 10.16 OFFICERS' AND DIRECTORS' DEFERRAL PLAN DEFFERRAL AND DISTRIBUTION ELECTION FORM NAME OF PLAN: Evans National Bank Deferred Compensation Plan for Officers and Directors Please complete the following accurately and with a BALLPOINT PEN; PRINT CLEARLY. The information you provide should be current as of the date the form is completed. All participants who have fulfilled the eligibility requirements to participate in the plan must complete all sections of the form. SECTION I. - GENERAL INFORMATION (Please complete and review and correct any information as needed.) ___________________________ __________________________ _______________________ ______________________ Last Name First Name Middle Initial Sex (M or F) ___________________________ __________________________ _______________________ ______________________ Social Security Number Date of Birth Employee # Date of Hire (mmddyy) (If applicable) (mmddyy) ___________________________ __________________________ Home Phone Work Phone ______________________________________________________________________________________________________________ Street Address ______________________________________________________________________________________________________________ Mailing Address _________________________________________________________ _______________________ ______________________ City State Zip

SECTION II. - DEFERRAL ELECTION (Check Yes & fill in % or check No.) _____ YES, I want to make a pre-tax deferral contribution to the Plan. I authorize the Bank to deduct the following percentage (no more than 100%) of my compensation from each paycheck and to credit that amount to pre-tax deferral portion of my Account. ______ Fee/Salary (if applicable) ______ Bonus (if applicable) ______ Other ______ NO, I do not wish to contribute to the Plan at this time. 86 SECTION III. - DISTRIBUTION ELECTION I hereby designate a one time election to have any distribution of the balance in my Deferred Compensation Account paid to me in installments as designated below: ______ One lump sum; ______ Five (5) annual installments and with the amount of each installment determined as of each installment date by dividing the entire amount in my Deferred Compensation Account by the number of installments then remaining to be paid, with the final installment to be the entire remaining balance in the Deferred Compensation Account; ______ Ten (10) annual installments with the amount of each installment determined as of each installment date by dividing the entire amount in my Deferred Compensation Account by the number of installments then remaining to be paid, with the final installment to be the entire remaining balance in the Deferred Compensation Account; or; ______ Fifteen (15) annual installments with the amount of each installment determined as of each installment date by dividing the entire amount in my Deferred Compensation Account by the number of installments then remaining to be paid, with the final installment to be the entire remaining balance in the Deferred Compensation Account. If a distribution election is not made herein, then the benefit shall be paid in ten (10) annual installments as set forth herein. SECTION IV. - AUTHORIZATION I authorize the Bank to effect the elections specified on this Deferral, Investment, and Distribution Election form. Any modification or revocation of this Distribution Election as elected by the participant in the signed written statement must be in writing, at least twelve (12) months prior to the date of the first scheduled payment and shall not be effective earlier than twelve (12) months after the modification is made. Additionally, such modification shall extend the deferral period for a period of at least five (5) additional years from the date the distribution was scheduled to begin. I understand that my elections will remain in effect until I submit a change according to the provisions of the Plan. Any modification to accelerate the distribution is prohibited. ___________________________________________ _________________ Participant Date 87