Form 1244

Revised 10/11/2016

Fiscal Year:

MONTHLY DEPOSIT OF RETIREMENT CONTRIBUTIONS

SC Public Employee Benefit Authority

South Carolina Retirement Systems

Box 11960, Columbia SC 29211-1960

EMPLOYER CODE

DUE DATE

EMPLOYER NAME

SCRS

Class II & Class III

RETIREMENT CONTRIBUTIONS

MONTH ENDING DATE

PORS

Class II & Class III

1. Member Contributions

    a. Active Member Contributions

    b. Retired Member Contributions

    c. Total Contributions (Line 1a + 1b)

2. Member Salaries

    a. Active Member Salaries

    b. Retired Member Salaries

    c. Total Salaries (Line 2a + 2b)

3. Employer Retirement Contributions (Line 2c x Rate)

     Rate SCRS:                    PORS:                  

4. Retiree Insurance Surcharge (Line 2c x Rate)

     Rate

5. Incidental Death Benefit Contributions (Line 2c x Rate)

     Rate SCRS:                    PORS:                  

6. Accidental Death Contributions (if covered) (Line 2c x Rate)

     Rate PORS:

7. Rounding Variance (up to +/- $0.99 allowed)

8. Net Remittance (Line 1c + 3 + 4 + 5 + 6 + 7)

9. Total Remittance 

       (Line 8 with SCRS, PORS totaled)

Contact Person

Signature

Telephone

Date

Email Address