Common Contracts

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July 10th, 2020

• Filed
  July 10th, 2020

Please read information on reverse side before completing Employee ID Effective As soon as possible Date: Later: See #7, p. 2 (Paycheck date) mm/dd/yyyy PART I: Employee Information Name Last First Middle Number of Pay Periods per Year9* 12 26 University of Wisconsin InstitutionUW- Work phone number This year I contributed to anotheremployer's voluntary retirement plan.Yes No E-mail Address Date of Birth I am age 50 or older this year.Yes No I own more than 50% of a business andhave a retirement plan with that business.Yes No *For those with 9-month appointments, contributions are taken only 9 times annually; no deductions are taken during the summer. PART II: Begin/Resume/Change I authorize the University to reduce my salary to allowfor the purchase of a 403(b)supplemental retirement benefit on my behalf and to remit the designated amounts each pay period to the provider(s) indicated below. I have read and will abide by the Participant Obligations stated on the reverse side of thi