ROGER WILLIAMS UNIVERSITY FACULTY
SALARY REDUCTION AGREEMENT and VENDOR SELECTION FORM
This is a:
New Agreement Change of Agreement Effective Payroll Date*: ______/______/_______
*Requested transaction(s) will be processed as soon as administratively possible upon receipt of this form.
Employee Name: _____________________________________________ Last four digits of SSN#:_____________________
NEW ELECTION
I elect to participate in the Roger Williams University Retirement Plan. I authorize the University/School of Law to withhold the amount elected
below in accordance with the following election. This election shall remain in effect until modified or revoked. I understand that the investment
of my deduction and any applicable match will be deposited by the retirement investment company in accordance with the investment
enrollment forms that I have completed.
MATCHED CONTRIBUTION:
(Enrollment is dependent upon being eligible for a matched contribution in accordance with the applicable plan
document.)
I elect to contribute Three Percent (3%) of my base salary per pay period and to remit this amount and the applicable employer match to the
following retirement investment company: (CHOOSE ONE ONLY)
TIAA-Cref or AIG
UNMATCHED CONTRIBUTION: (You may remit the unmatched contribution to either one or both retirement investment companies.)
I elect to contribute $
of my base salary per pay period and to remit this amount to TIAA-Cref; and/or
I elect to contribute $ of my base salary per pay period and to remit this amount to AIG.
If you have a waiting period before receiving a matching contribution and you elect during that waiting period to contribute five or more percent
of your base salary you will automatically begin receiving the employer matching contribution upon completion of your waiting period. You
will, however, be required to complete a new carrier election form at such time.
THIS AGR
EEMENT shall supersede any prior Salary Reduction Agreement and Vendor Selection Form to the extent that it contradicts
and/or changes such Agreement and Form. The Agreement shall be legally binding and irrevocable as to each of the parties hereto while
employment continues; provided, however, that either party may terminate this Agreement as of the end of any month, so that it will not apply
to salary subsequently paid, by giving at least thirty days written notice of the termination. The Employee agrees that the total contributions
on his/her behalf do not exceed the applicable limitations of Sections 403(b), 402(g), 415 or other applicable sections of the Internal Revenue
Code of 1986 as amended, and/or that the University/School of Law has no obligation or liability to calculate or verify such limitations. The
Employee further agrees that the University/School of Law shall have no liability whatsoever for any loss suffered by the Employee with
regard to his/her selection of a retirement invested insurance company contract or associated contract or investments. The Employee
understands that the University/School of Law does not recommend to the Employee that he/she participate or not participate in the Roger
Williams University Retirement Plan and the University/School of Law do not warrant any particular tax consequences to the Employee as a
result of such participation.
Employee Signature: Date of Agreement:
_______/________/________
HUMAN RESOURCES USE ONLY BELOW THIS LINE
Unmatched Contribution Eligibility Date:_______/________/________ Matched Contribution Eligibility Date: _______/________/________
Matched Contribution Eligibility: (Hours scheduled and/or worked and the applicable class waiting period below):
Requested Transaction processed effective Payroll Date: _______/________/________
Date Last Revised: 10/2019
CHANGE OR STOP CONTRIBUTION(S):
I elect to change my unmatched contribution to $ of my base salary per pay period.
I elect to stop my 3% matched contribution.
I elect to stop my unmatched contribution.
This election shall remain in effect until modified or revoked.
CHANGE IN
VESTMENT COMPANY:
(Transfers are subject to the provisions, restrictions and applicable fees of each VENDOR.)
I elect to change remittance of future matched contributions from TIAA-Cref or AIG to TIAA-Cref or AIG
I elect to change remittance of future unmatched contributions from TIAA-Cref and/or AIG to TIAA-Cref and/or AIG
(If you are splitting your unmatched contributions between both retirement investment companies, please identify the percentage
split allocation here _____%TIAA-Cref and ____% AIG.)
This election shall remain in effect until modified or
revoked.
