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_______________________
___________________________________ ___________________
Boise State University – Human Resource Services
AGREEMENT FOR SALARY REDUCTION UNDER SECTION 403(b)
BY THIS AGREEMENT, made between _________________________ (Employee) and Boise State
University, the parties hereto agree as follows:
Effective for amounts paid on pay date __________________, 20____, which date is
subsequent to the execution of this Agreement, the Employee’s salary will be reduced by the amount
indicated below.
This agreement is legally binding and irrevocable for both Boise State University and the
Employee while employment continues. However, either party may terminate or otherwise modify
this Agreement as of the end of any pay period by giving at least thirty days written notice so that
this Agreement will not apply to salary subsequently paid.
The amount of salary reduction* shall be $___________per pay period (biweekly). The
amount specified above will be paid to _________________________ (retirement vendor) as
premiums on Supplemental Annuity Contract(s).
This amount will produce a total contribution that does not exceed the Employee’s statutory
limitation under IRC Section 415 or Section 402(g), whichever is less. For employees age 50 and
over, this amount will include any additional catch-up contribution permitted under IRC 414(v).
Signed this ______ day of _______________, 20____
Employee Signature
Employee ID Number
Boise State University Representative Date
*It is important that you don’t withhold more than your pre-tax maximum allowable deduction to a
supplemental retirement account in one calendar year. We recommend you contact your retirement
representative to determine that amount.
Please return to: 1910 University Drive •A-218 • Boise, ID •83725-1265
Phone: 208-426-1616 • Fax: 208-426-3100
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