Form of Mineola Community Bank Split Dollar Life Insurance Plan Participation Agreement for certain executive officers
MINEOLA COMMUNITY BANK
SPLIT DOLLAR LIFE INSURANCE PLAN
I, an eligible Employee as determined in Section 2.1 of Mineola Community Bank Split Dollar Life Insurance Plan (the “Plan”) dated December 18, 2013 hereby elect to become a Participant of the Plan in accordance with Section 2.2 of the Plan.
I acknowledge that I have read the Plan document and agree to be bound by its terms.
The death benefit to which my Beneficiary is entitled is the lesser of $100,000 or (ii) the Net Death Proceeds.
Executed this day of _______.
|Received by the Administrator this||day of||.|