Complete the information below if you had NO reportable earnings
(* = required field)
CERTIFICATION AND SIGNATURE:
I certify that to the best of my knowledge the above information is true and correct. I understand that falsification of information will result in the termination of my IU 18/20 Retirement Plan benefits. I understand, if requested by Indiana University, I must provide documentation of my reported earnings for all periods of time during which I received IU 18/20 Retirement Plan benefits and if this request is not fulfilled in a timely manner it will result in the termination of my IU 18/20 Retirement Plan benefits.
Typing my name in the space provided constitutes an electronic signature and certifies that the information supplied on this form is true and correct.