Payroll Deferment Form
For Teaching/Research Assistantships Only
REGULATIONS PERTAINING TO PAYROLL DEFERMENT AGREEMENTS
I authorize all valid charges to be deducted from any/all monies owed to me through the Payroll Department at the
University of Windsor and accept responsibility to ensure that such deductions are actually made.
The amount per pay will be determined by Payroll from a total balance indicated by Cashiers. Any/all revisions of
charges during the semester, resulting from periodic audits, will be forwarded to Payroll for adjustment effective the
next available payroll. The Cashiers’ Office will notify the student of any balance that cannot be recovered through
payroll and payment will be due and payable immediately at the Cashiers’ Office.
Cancellation or withdrawal is not possible by telephone, by stopping payment on cheques or by failure to attend
classes, but must be done on the UWinsite Student website.
I understand and accept responsibility for the terms of this deferment and agree to pay my account in full during the
semester indicated. I also understand that ACADEMIC and RESIDENCE privileges may be canceled if the above
arrangements are not met and any outstanding debt will be subject to daily interest and other fees incurred to the date
of cancellation.
I have read all of the above regulations pertaining to payroll deferment agreements and accept this contract,
including the rules and regulations indicated above.
Teaching Assistant
Department: Gross Income for Term:
Research/Grant Assistant
Department: Gross Income for Term:
Please indicate if you will be receiving
any of the following for the term:
Grad Tuition Scholarship
Visa Differential Bursary
Other Awards Amount:
Student Signature:
Date Approved: Cashiers Office Use Only
Total Charges:
Award(s) Amount:
Total Fees for
Payroll Deferral:
Available Payroll:
Student to Pay:
Student ID:
First Name:
Family Name:
Date Submitted:
Term:
Year:
Employee Number:
*Total amount available for deferment
will be subject to statutory deductions.
Total Gross Income:
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signature
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