Company Name: Division:October 9th, 2020
FiledOctober 9th, 2020Beginning I wish to have the following amounts deferred in each category under the Cafeteria Plan. Any previous election and compensation reduction is hereby revoked. These amounts will continue for each succeeding pay period until the agreement is amended or terminated. I understand that I cannot terminate insurance policies and change these amounts prior to the next plan year unless there is a change in family status, or in employment status, or other special circumstances. I understand that my Social Security benefits may be reduced.