NAME, MEMBERSHIP NUMBER, AND SOCIAL
SECURITY NUMBER Information that identifies the individual
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 of Contributions.
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.
PENSION DEDUCTION 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.")
SUPPLEMENTAL ANNUITY 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).
CONTRIBUTORY INSURANCE EFFECTIVE
Effective date of contributory insurance deductions. All
deductions must be remitted with the first Quarterly Report
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
group life 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
ALL DEDUCTIONS BEGIN
The date when deductions from the salary of the member begin.
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
NAME OF EMPLOYER AND LOCATION
NUMBER Employer name and identification number.
comments regarding this certification.
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 e-mail us.