Rochester College
Rochester College
Retirement Contribution Change Form
This form is to be used only for changes to the contributions you have currently elected. If you would like to enroll in the 403(b) plan, please contact the Human Resources Director at Ext. 2018.
| |If this is a change to a current authorization, indicate in which pay period this change should be effective: |
| |Month: 15th of the month end of the month |
|Voluntary Contribution* |
|Indicate the fixed dollar amount or percentage you elect to have deducted from your pay as a voluntary retirement contribution under the |
|403(b) retirement plan: |
| | | | |
|Amount per pay period:| | | |
| |$ | | |
|OR | | | |
|Percentage of gross | | | |
|pay: |% | | |
|*Voluntary Contribution must be either a fixed dollar amount or a percentage - it cannot be both. |
| | | | | |
|Printed Name | |Signature (required) | |Date |
* * * * * * * Human Resources Department Only * * * * * *
Entered into Payroll System By: ____________________ Date: _______________
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