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2021 HSA Election Form Please complete the following: First Name. I. Last nameEmployee #Your Health Saving Account belongs to you and is your financial asset even if you change employers. Your contributions
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Clearly understand the purpose for which Deloitte is contributing $500.
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Ensure you have the necessary documentation or information required to fill out the contribution form.
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Follow the instructions provided on the form carefully and accurately.
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Double-check all information filled out to avoid errors or discrepancies.
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Submit the completed form to the appropriate department or individual within Deloitte.

Who needs if deloitte contributes 500?

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Employees who are seeking financial assistance for a specific project or event.
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Non-profit organizations or charities that are recipients of Deloitte's contributions.
03
Students or educational institutions receiving funding from Deloitte for scholarships or programs.
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A contribution of 500 is made by Deloitte.
The entity receiving the contribution from Deloitte is required to file.
The form must be completed with all relevant information regarding the contribution from Deloitte.
The purpose is to accurately report the contribution from Deloitte for transparency and compliance.
The amount of the contribution, details of the contribution, and any other relevant information.
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