AMOUNT PER PAYCHECK. Enter an amount for each carrier with which you wish to participate. To discontinue contribution enter zero. FIDELITY PRE-TAX FIDELITY XXXX (POST-TAX) TIAA- GSRA PRE-TAX TIAA-GSRA XXXX (POST-TAX) TIAA-RA PRE-TAX TIAA-XX XXXX (POST-TAX) $ $ $ $ $ $ Total 403(b) voluntary pre-tax and Xxxx (post-tax) contributions cannot exceed your annual contribution limit. EMPLOYEE SIGNATURE RETIREMENT OFFICE AUTHORIZATION DATE DATE Print Reset Form DAYTIME TELEPHONE NUMBER Return To: HR Benefits @xxx.xxx, fax to 000-000-0000 or mail to 000 Xxxxxxx Xxxx, Lexington, Kentucky 40506-0064
AMOUNT PER PAYCHECK. Enter an amount for each carrier with which you wish to participate. To discontinue contribution enter zero. FIDELITY PRE-TAX FIDELITY XXXX (POST-TAX) TIAA- GSRA PRE-TAX TIAA-GSRA XXXX (POST-TAX) TIAA-RA* PRE-TAX TIAA-RA* XXXX (POST-TAX) $ $ $ $ $ $ Total 403(b) voluntary pre-tax and Xxxx (post-tax) contributions cannot exceed your annual contribution limit. EMPLOYEE SIGNATURE RETIREMENT OFFICE AUTHORIZATION DATE DATE Print Reset Form DAYTIME TELEPHONE NUMBER *RA plans are only available to employees hired prior to 7/1/2015 who have been previously enrolled in the plan. Return To: HR Benefits @xxx.xxx, fax to 000-000-0000 or mail to 000 Xxxxxxx Xxxx, Lexington, Kentucky 40506-0064
AMOUNT PER PAYCHECK. Enter an amount for each carrier with which you wish to participate. To discontinue contribution, enter zero. FIDELITY PRE- TAX FIDELITY XXXX (POST-TAX) TIAA- GSRA PRE- TAX TIAA-GSRA XXXX (POST-TAX) TIAA-RA PRE- TAX TIAA-XX XXXX (POST-TAX) $ $ $ $ $ $ Total 403(b) voluntary pre-tax and Xxxx (post-tax) contributions cannot exceed your annual contribution limit. EMPLOYEE SIGNATURE RETIREMENT OFFICE AUTHORIZATION DATE DATE DAYTIME TELEPHONE NUMBER
AMOUNT PER PAYCHECK. Enter an amount for each carrier with which you wish to participate. To discontinue contribution, enter zero. FIDELITY PRE- TAX FIDELITY XXXX( POST-TAX) TIAA- GSRA PRE-TAX TIAA-GSRA XXXX (POST-TAX) $ $ $ $ Total 457(b) voluntary pre-tax and 457(b) Xxxx (post-tax) contributions cannot exceed your annual contribution limit. EMPLOYEE SIGNATURE RETIREMENT OFFICE AUTHORIZATION DATE DATE DAYTIME TELEPHONE NUMBER Return Form To: HR Xxxxxxxx@xxx.xxx, fax to 000-000-0000 or mail to 000 Xxxxxxx Xxxx, Lexington, Kentucky 40506-0064
