By submitting this form, I approve for the setup of the requested payroll earning or deduction code to be used by my company as outlined in this form. I have reviewed and have noted any special taxation or instructions related to this code, as well as whether or not the new code should be included as 401(k) earnings for deferral and match calculations according to my employer’s plan document. Therefore, I assume any related liability in the event that the information provided is found to be inaccurate.