SOUTHWIND BENEFITS WAIVER NOTICE 2026 (copy)

SOUTHWIND BENEFITS WAIVER NOTICE 2026

Name *

Date of Birth *

WAIVER ELECTION:

WAIVE: I wish to not enroll in any of the benefits offered by Southwind. *

NOTICE:

By checking the box above and signing below, I understand I am waiving my right to elect any employee benefit options offered by Southwind Enterprises for 2026 Open Enrollment. I acknowledge that I have until 11/18/25 to rescind my waiver by emailing payroll@wearesouthwind.com.

EMPLOYEE SIGNATURE

Employee Signature *

Today's Date *