Page 178 - Essentials of Payroll: Management and Accounting

EXHIBIT 6.2 Benefits
Deduction Authorization Form

I hereby authorize that the following deductions be made from my pay:

Deduction Type Deduction Start Stop
Amount Date Date

■ Cafeteria Plan—Dependent Care _________ ______ ______
■ Cafeteria Plan—Medical _________ ______ ______

■ Dental Insurance _________ ______ ______
■ Dependent Life Insurance _________ ______ ______

■ Long-Term Disability Insurance _________ ______ ______
■ Medical Insurance _________ ______ ______

■ Short-Term Disability Insurance _________ ______ ______
■ Supplemental Life Insurance _________ ______ ______

Signature Date

These forms should be kept in employee payroll files for immediate
access in case an employee later challenges the amount of a deduc-
tion. To keep these challenges from occurring, it is useful to have
all deductions identified separately on the remittance advice that
accompanies each paycheck. For example, if there are deductions
for short-term disability and long-term disability insurance, the
amount of these deductions should be separately listed.

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