Tiaa-Cref Voluntary Tax-Defered Annuity Plan Form

TIAA-CREF VOLUNTARY TAX-DEFERED ANNUITY PLAN

SALARY REDUCTION AUTHORIZATION FORM FOR BENEFITS

ELIGIBLE AND TEMPORARY EMPLOYEES

Human Resources, Skytop Office Bldg., 443-4042

I, _________________________________ (please print), authorize Syracuse University to reduce my

“Eligible Earnings,” as defined in the Syracuse University TIAA-CREF Voluntary Tax-Deferred Annuity

Plan (the “Plan”), by the amounts indicated below and remit such amounts to TIAA-CREF on my behalf

pursuant to the Plan.

Enter either a dollar amount or a percentage of Eligible Earnings for each option.*

Voluntary Group Supplemental Retirement Annuity

$_________ per pay period

______ % of Eligible Earnings

Before-Tax Election:

$_________ per pay period

______ % of Eligible Earnings

Roth 403(b) After-Tax Election:

Voluntary Supplemental Retirement Annuity (only available to employees with an existing Voluntary

Retirement Account)

$_________ per pay period

______ % of Eligible Earnings

Before-Tax Election:

$_________ per pay period

______ % of Eligible Earnings

Roth 403(b) After-Tax Election:

I understand that my total annual contributions to the Plan cannot exceed the annual limit on such

contributions, as imposed by the Internal Revenue Code, and that the Office of Human Resources will

suspend the salary reductions when this limit has been met.

I understand that this election supersedes all prior elections and shall be effective as indicated below

provided all other requirements of the Plan are fulfilled.

______

I would like the election to be effective as soon as administratively feasible.

______

I would like to delay the election to be effective on the pay cycle beginning on

__________ (mm/dd/yy).

I understand that this Agreement is legally binding and irrevocable with respect to amounts paid while the

Agreement is in effect and that I may amend the elections at any time with respect to future amounts.

Employee’s Signature: ____________________________________

Date: __________________

Employee’s SUID #: _____________________

Return to:

Syracuse University

Accepted and Agreed to:

HR Service Center

SYRACUSE UNIVERSITY

Skytop Office Building

Syracuse, New York 13244

By: ______________________

Phone/ 443-4042 -- Fax/ 443-1063

Date: __________________

Emp Status Permanent Temporary

hrservic@syr.edu

* You can view your account and contribution amounts via MySlice, including past elections. From the Employee Services pagelet select View

My Benefits Summary for a complete listing of all benefits. For additional information, contact TIAA-CREF directly at 1-800-842-2776.

1756379.4 Jul 2011 MODIFIED

Tiaa-Cref Voluntary Tax-Defered Annuity Plan Form -

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