HomeMy WebLinkAboutContract 28042 Cif Y ECR ARY
e @NA ACT a
TEXAS LIFEI INS URANCECOMPANY VOLUNTARY LIFE
A MetLife®Company
Voluntary Payroll Deduction Employer Agreement
Texas Life Insurance Company and C: For Wor46 (Employer),
agree to provide for the Employer's eligible employees a Payroll Deduction Program for payment of
premiums on Texas Life's '(IL -1 1 0 P1 KS Program.
The employer will deduct from the salary or wages of all participating employees the premiums on
their and/or their family members policies and will remit the amount so deducted to Texas Life In-
surance Company at its Home Office in Waco, exas,on the Common Due Dates(s),(as defined be-
low). The employer will give prompt notice to (%I no, aS hkw c''u r,
Agent,or to the Home Office of the Company, of the name(s)and policy number(s)of any participant
who leaves its employ,changes or withdraws a payroll deduction authorization,dies, or for whom
payroll deductions will no longer be made for any reason.
Eligible employees will be those who have been employed for the minimum time required for the
payroll deduction program selected at enrollment date and
(Other Requirements,if any) CAP
U�A 19
The Common Due Date for this Program is the day of each month and the first Common
Due Date for this Program will be 1 / 1 / 3 (Month,Day,Year).
Texas Life will furnish to the Employer as part of each bill a detailed statement showing the indi-
vidual and total amounts due and any current changes,according to its records at billing date.
TERMINATION
This agreement may be terminated at any time by the Employer or by Texas Life Insurance Com-
pany upon furnishing 90 days written notice. If this agreement is terminated,the Employer will be
responsible only for the remittance to Texas Life of any full premiums deducted prior to the termi-
nation date. In the event deductions for any particular policy are to be discontinued on other than
a Common Due Date,the amounts already withheld from pay,if any,are to be refunded to the em-
ployee,and Texas Life is to be notified as provided above.
Executed this th day of 0 l_Dbe
Texas Life Insurance Company,Waco,Texas Employ r
By: By:
X42..
4erge6iller,Vice President Print Name
Title:
A PR VED 0 F AND LEGAU Y: p BY
FORM 1356 R03/00 ,y 9t �
_. _._. ._. lit�tu�.
cotl�EA @t Authorization
�►TM y� SHI�GTON Avf I POST OFFICE BOX 8jO 1 WACO.TEXAS 76703-o830 1 800-283-9?33 254 75z 6521 WWW_texas)ife.COm
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