EXHIBIT 4.3
DEFERRED COMPENSATION PLAN [photographs of faces omitted]
ROLLINS, INC.
2006 ANNUAL BASE SALARY DEFERRAL & DISTRIBUTION ELECTION FORM
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First Name Middle Initial Last Name
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Street Address City State Zip Code
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Social Security Number Date of Birth Date of Hire
(NOTE: THIS FORM MUST BE COMPLETED AND RETURNED TO WESTPORT WORLDWIDE NO LATER THAN DECEMBER 16, 2005.)
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> DEFERRAL ELECTION PLEASE MAKE your elections by checking the applicable circle and completing any
applicable blank. You must defer in 1% increments, and you must defer at least $2,000
from Annual Base Salary earned during 2006 ("2006 Annual Base Salary") to participate
for the 2006 Plan Year with respect to Annual Base Salary (If you wish to defer Annual
Base Salary for the entire year, please check Election A and Election B).
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o 2006 BASE SALARY DEFERRAL I ELECT to defer __________% (maximum of 50%) of my Base Salary earned from JANUARY 1,
ELECTION A 2006 THROUGH JUNE 30, 2006.
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o 2006 BASE SALARY DEFERRAL I ELECT to defer __________% (maximum of 50%) of my Base Salary earned from JULY 1,
ELECTION B 2006 THROUGH DECEMBER 31, 2006.
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o NON- PARTICIPATION I ELECT not to defer any of my 2006 Annual Base Salary to the Plan.
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> SHORT-TERM PAYOUT ELECTION PLEASE CHECK applicable circles below and complete
applicable blanks.
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2006 ANNUAL BASE SALARY o I ELECT to receive a lump-sum SHORT-TERM PAYOUT of my 2006 Annual Base Salary
SHORT-TERM PAYOUT deferrals, and earnings or losses thereon (based on my Measurement Fund selections),
(Please Select ONE Option) payable in JANUARY OF 20____ (MUST BE AT LEAST 2010), in accordance with Article Four
of the Plan. I understand that I may make a subsequent election to further postpone
payment beyond this date, subject to the terms and limitations of Section 4.1 of the
Plan.
o I ELECT NOT to receive a SHORT-TERM PAYOUT of my 2006 Annual Base Salary
deferrals, and earnings or losses thereon (based on my Measurement Fund selections).
I understand that regardless of my election above, the Plan provisions governing the
Retirement Benefit, Termination Benefit, Pre-Retirement Survivor Benefit or Plan
termination payout will apply if they become operative before the date elected above.
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(OVER)
2006 ANNUAL BASE SALARY DEFERRAL & DISTRIBUTION ELECTION FORM CONTINUED. . .
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> RETIREMENT DISTRIBUTION ELECTION PLEASE CHECK applicable circles below and complete applicable blanks.
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NOTE: YOU MUST COMPLETE A RETIREMENT DISTRIBUTION ELECTION DURING THIS ENROLLMENT PERIOD REGARDLESS OF YOUR SHORT-TERM
PAYOUT ELECTION ABOVE.
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2006 ANNUAL BASE SALARY o I ELECT to receive a lump-sum RETIREMENT BENEFIT PAYOUT of my 2006 Annual Base
RETIREMENT BENEFIT PAYOUT Salary deferrals, and earnings or losses thereon (based on my Measurement Fund
(Please Select ONE Option) selections), payable during the January or July of the Plan Year following my
Retirement, in accordance with Article Five of the Plan.
o I ELECT to receive a RETIREMENT BENEFIT PAYOUT of my 2006 Annual Base Salary
deferrals, and earnings or losses thereon (based on my Measurement Fund
selections), IN ____ ANNUAL PAYMENTS (ENTER BETWEEN 2 AND 15), commencing during
the January or July of the Plan Year following my Retirement, in accordance with
Article Five of the Plan.
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ACKNOWLEDGMENT AND AGREEMENT PLEASE SIGN below.
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The Plan is subject to Internal Revenue Code Section 409A, which was added by the recently enacted American Jobs Creation Act of
2004 (the "Jobs Act"). The Jobs Act regulates deferral and distribution elections and many other aspects of the Plan. As of
November 2005, there are many legal issues related to the Jobs Act that are yet unresolved, and it is expected that the IRS will
issue further guidance to address some of these issues. Please note that Rollins, Inc. has reserved the right to amend the Plan
to comply with the Jobs Act. Such amendments might be retroactive - meaning that they might apply to amounts already contributed
before the amendments are adopted.
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I ACKNOWLEDGE that I have been offered an opportunity to participate in the Rollins, Inc. Deferred Compensation Plan. I will
participate (or not participate) in the Plan in accordance with my elections on this form and authorize the Company to make the
appropriate deductions (if any), as indicated on this form, from my 2006 Annual Base Salary, and the Plan Committee to apply the
distribution elections, as indicated on this form, to the appropriate portion of my Account Balance. I understand that I may not
change the above deferral election for the remainder of 2006 (except that the above deferral election may be reduced if necessary
to cover FICA taxes and/or other payroll reductions), that the above deferral election will apply only for 2006 Annual Base
Salary, that a new election will be required if I wish to defer 2007 Annual Base Salary, and that amounts deferred under the Plan
are unfunded and unsecured, and subject to the claims of the Company's creditors in the event of the Company's insolvency. I
further understand that I may change the above distribution elections solely as permitted under the Plan and under the Jobs Act.
I further understand that the amounts subject to deferral under this election shall be subject to such rules as are necessary to
preserve the tax-deferred status of these amounts under the Jobs Act. Unless otherwise defined herein, capitalized terms used in
this form shall have the meanings given them in the Plan.
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Signature of Employee _____________________________________________________ Date__________
Signature of Plan Committee Member
Or Duly Authorized Agent __________________________________________________ Date__________
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