Sample Payroll Deduction Authorization Form printable pdf download

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Payroll Deduction Authorization Form Sample

Posted @ 3/19/2011 12:14 PM by MBAHRO

| Files in Payroll Outsourcing,Templates

Calculating payroll deductions properly is a top priority for all companies. There are many important steps

to keep in mind during this process. Payroll is considered the sum of all financial records of employees

(including salaries, wages, bonuses, any other payments, as well as all deductions).

Here is a free sample of a payroll deduction authorization sample. You can tailor it to your needs. For

example, if an employee does not want the 401(k) option, you can remove that reference.

PAYROLL DEDUCTION AUTHORIZATION FORM

Company: _____________________________________________________________

Employee Name: _______________________________________________________

Employee Title: ______________________________ ID # ______________________

Department: ___________________________________________________________

I (add employee name) authorize (add company name) to make the following deductions from my gross

earnings every month, beginning (start month and year).

401(K) Plan

% of net pay

Employee Savings Plan

% of net pay

Union Dues (if applicable)

% of net pay

Loan Repayment (if applicable)

% of net pay

Parking Fees

TOTAL:

Total Amount: _________________________

I understand and acknowledge the deduction may not be made if I have insufficient income during a pay

period.

I understand and acknowledge dues such as Income Tax and Social Security Tax take priority over these

deductions.

I understand deductions may not take effect during the current payroll cycle.

I will not hold (company name) liable for any deductions that are not made.

Employee Signature: _____________________________________

Employee Name (printed): _________________________________

Date: __________________________________________________

FOR PAYROLL USE

Received (date)

By: ____________________________

Action Taken (date)

Initials: ___________________

Properly managing payroll is not easy. A good system should be in place to ensure payroll deduction

authorization forms are properly collected and errors are prevented. Slips can be numbered as they come

in and a log may be maintained to help keep track of the forms. The information should also be recorded

electronically.

Also, be sure to let employees know when the deductions will take effect. Generally, deductions would

activate during the following payroll processing period after they were received.

10/11/2017

Sample Payroll Deduction Authorization Form

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