GRADUATE STUDENT DEDUCTION AUTHORIZATION

Full Payroll Deduction Policy available at www.mun.ca/regoff/comtroller/GradStudDedAuthPolicy.html

Name ____________________________________

Social Insurance Number _____________________

Department ________________________

Student Number: ____________________

	FALL ______	WINTER ______	SPRING ______
Tuition Fees	____________________	____________________	____________________
Burtons Pond Apartments	____________________	____________________	____________________
GSU Fees	____________________	____________________	____________________
Foreign Health Insurance	____________________	____________________	____________________
Dental Plan	____________________	____________________	____________________
Health Plan (Canadian)	____________________	____________________	____________________
Recreation Fee	____________________	____________________	____________________
Total	$___________________	$___________________	$___________________

To be Completed by the Cashier's Office:

Number of Deduction Periods
Bi-weekly Deduction Amount

DEDUCTION AUTHORIZATION:

I hereby authorize Human Resources to deduct from my Fellowship/Bursary bi-weekly deductions of $______ for the Fall Semester, $______ for the Winter Semester and bi-weekly deductions of $______ for the Spring Semester. Should the tuition fee structure change, the amount of my deduction will change accordingly. Deductions will commence on the second pay period of each semester if this authorization has been completed prior to the commencement of the semester.

I accept responsibility to notify the Cashier's Office should additional charges for emergency loans, library fines, penalties, etc., be incurred in order to adjust my payment schedule.


Student Signature _______________________________	Date _____________________ 

Copies 1-3 Human Resources	4 - Cashiers Office 	5 -  Student