EXHIBIT 1
FORM OF DEFERRAL ELECTION AND BENEFICIARY DESIGNATION
This election is made pursuant to the Citizens First Group Directors' Deferred
Fee Plan effective as of April 21, 2003 (as subsequently amended in accordance
therewith, the "Plan") and is governed by the Plan's terms and conditions.
Capitalized terms not otherwise defined in this document will have the meanings
given to them in the Plan.
DEFERRAL ELECTION CHOICE
/ / I elect to defer: ________% of my Fees.
$________ of my Fees.
/ / I elect not to defer my Fees.
(Deferral Election choice to be completed only by, and therefore
valid only for, Prospective Non-Employee Directors.)
BENEFICIARY DESIGNATION
In the event of my death, all of my Plan benefits shall be paid to my
following beneficiary or beneficiaries (if multiple beneficiaries are
designated, benefits will be paid in equal shares unless specific percentages
are also designated):
PERCENTAGE
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The share of any of the above named beneficiaries who do not survive me shall be
paid to:
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If the box below is checked, I understand that my Beneficiary Designation is
irrevocable unless the Committee consents to my revocation of my Beneficiary
Designation.
/ / Beneficiary Designation irrevocable unless the Committee
consents to my revocation of my Beneficiary Designation.
TRIGGER DATE FOR SETTLEMENT OF BENEFITS
I elect the following as the "Trigger Date," meaning that I will begin
receiving benefits at the time specified in the Plan following this date:
/ / my Termination of Service;
/ / my Normal Retirement Date;
/ / the following specific date which shall not be later than
my Normal Retirement Date as long as this date occurs after
my Termination of Service: .
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(Note that I understand that, regardless of what I elect above, (a) in
no event will the "Trigger Date" be later than my Normal Retirement
Date and (b) if I specify a date in the third option that is before my
Termination of Service, the Trigger Date will be the earlier of my
Termination of Service and my Normal Retirement Date.)
FORM OF SETTLEMENT OF BENEFITS
I elect to receive benefits in accordance with the Plan:
/ / in ________ equal quarterly installments (Director to complete blank)
/ / in one "lump sum"
(Note that (1) Former Non-Employee Directors are permitted to elect a "lump
sum" settlement only if that was the form of settlement elected under his or her
Prior Agreement, and (2) I understand that, regardless of what I elect, the
maximum number of quarterly installments will be 80.)
Date:
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Director
Accepted by Company this day of , 2003.
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By:
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Its:
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