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Payroll Deduction Authorization Form - 1

The employee authorizes payroll deductions from their gross earnings starting in a designated month and ending in another designated month. The deductions include 401(k) contributions, employee savings plan contributions, loan repayments, and union dues. The total deduction amount is provided in words. The employee understands that deductions may not occur if earnings are insufficient and that statutory taxes take precedence over voluntary deductions. The employee agrees not to hold the company liable for deductions made or not made.

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resar17_rgt
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© Attribution Non-Commercial (BY-NC)
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219 views

Payroll Deduction Authorization Form - 1

The employee authorizes payroll deductions from their gross earnings starting in a designated month and ending in another designated month. The deductions include 401(k) contributions, employee savings plan contributions, loan repayments, and union dues. The total deduction amount is provided in words. The employee understands that deductions may not occur if earnings are insufficient and that statutory taxes take precedence over voluntary deductions. The employee agrees not to hold the company liable for deductions made or not made.

Uploaded by

resar17_rgt
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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PAYROLL DEDUCTION AUTHORIZATION FORM

Employee Name: _____________________________________________________


Designation: ______________________________ ID # ______________________

Department: _________________________________________________________

I hereby authorize (add name of the company here) to make the following deductions from my
gross earnings every month, start from (starting month) and ending at (end month)

401(k) Plan $ / % of net pay

Employee savings Plan $ / % of net pay

Loan Repayment to ____________________ $ / % of net pay

Union Dues $ / % of net pay

TOTAL

Total (in words) _____________________________________________________

I understand that the deduction may not be made if I have insufficient income in a pay period
I understand that statutory dues such as Income Tax and Social Security Tax take precedence
over these deductions
I understand that the deductions may not take effect during the current payroll cycle
I will not hold the company liable for any deductions made or not made

Signature:

Name:

Date:

FOR PAYROLL USE

Received on (date) Initials ________


Action Taken on (date) Initials ________

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