CERTIFICATION OF PAYROLL DEDUCTIONS
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INFORMATION SHOWN ON
NUMBER, AND SOCIAL SECURITY NUMBER
Information that identifies the individual member.
ACCUMULATED BASE SALARY
Total base salary on creditable service from January
1st to the date of certification. This amount will be shown
as Accumulated Base Salary on the next Quarterly Report
SALARY THIS QUARTER
Base salary from the date of certification to the end
of the current calendar quarter. (For members paid through
State Centralized Payroll this field will read "Biweekly.")
FULL PENSION RATE
The member's percentage rate of full pension contribution.
Amount of pension contribution on base salary this
quarter computed by multiplying the Rate of Contribution by
the salary for the quarter. (For members paid through State
Centralized Payroll this field will read "Biweekly.")
COLLECTIVE TRUST Percent of base salary that the
member wishes to voluntarily contribute to the Supplemental
Annuity Collective Trust (Chapter 123, P. L. 1963). Contributions
shall be in even dollar amounts rounded to the nearest dollar
($0.50 and over rounded to the next highest dollar).
EFFECTIVE Effective date of contributory insurance
deductions. All deductions must be remitted with the first
Quarterly Report of Contributions.
Special cases in which the member must have a medical
examination to qualify for contributory insurance coverage.
In some cases, a medical examination may also be required
for noncontributory insurance coverage.
DATE OF BIRTH, DATE
OF ENROLLMENT, DATE OF TRANSFER, MONTHS OF PRIOR SERVICE,
AND ENROLLED AS Items of information which determine
service credit prior to enrollment and the type of membership
under which the member may retire.
ALL DEDUCTIONS BEGIN
The date when deductions from the salary of the member
NUMBER OF PAYMENTS,
AMOUNT PER PAYMENT, AND TOTAL AMOUNT OF OBLIGATION
Status of various obligations on certification date.
IMPORTANT When this form
is used to certify new or revalued arrears or loan schedules,
only the information pertaining to the new deduction is shown.
Normal deductions are still due for any period in which the
member was employed. Previously certified arrears or loan
deductions are replaced by the new deduction. The certification
which establishes an arrears or loan is to be added to the
deduction made for normal pension.
NAME OF EMPLOYER AND
LOCATION NUMBER Employer name and identification
Additional comments regarding this certification.
QUESTIONS OR FOR MORE INFORMATION
If you have specific questions regarding
the Certification of Payroll Deductions, you may call
the Division's Office of Client Services at (609) 292-7524,
write to the Division of Pensions and Benefits, PO Box 295,
Trenton, NJ 08625-0295, or send us email.