9. Accidental Death Contributions (if covered) (Line 5 x Rate)

     Rate PORS:                     

8. Incidental Death Benefit (Line 5 x Rate)

     Rate SCRS:                    PORS:                  

7. Retiree Insurance Surcharge (Line 5 x Rate)

     Rate

Form 1246

Revised 1/10/2019

Fiscal Year:

QUARTERLY CONTRIBUTION REPORT SUMMARY - CLASS II EMPLOYER

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

QUARTER ENDING DATE

PORS

Class II & Class III

1. Member Salaries 

    a. Active Member Salaries

    b. Retired Member Salaries

    c. Total Salaries  (Line 1a + 1b)

2. Total Member Contributions (Line 1c x Rate)

3. Total Member Contributions Withheld - per detail report

4. Variance (Line 2 - Line 3)

    If variance is greater than $4.99, please review for errors

5. Total Salaries

     SCRS: Line 1c;   PORS: Line 1c

6. Employer Retirement Contributions (Line 5 x Rate)

     Rate SCRS:                    PORS:                    

16. Total Remittance (Line 15 with SCRS, PORS totaled)

10. Total Due for the Quarter (Line 3 + 6 + 7 + 8 + 9)

11. Monthly

      Deposits

      Remitted

12. Net Amount Due for the Quarter (Line 10 - Line 11)

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

13. Authorized Credits and Debits (attached copy of invoice)  

      Invoice Numbers:

15. Net Remittance (Line 12 + 13 + 14)

Contact Person

Signature

Telephone

Date

Email Address