Option Form for Seventh Bi-Weekly Payroll Payments 
                                                               For Rating Purposes Only 
Choose either the deletion method or the apportion method, then provide the requested information in the appropriate columns. 
                                                              
       Deletion Method                                          Apportion Method
 Seventh bi-weekly payroll payment of wages paid during        The seventh bi-weekly payroll payment
 a quarter to be deleted entirely from the quarter for the     will be apportioned equally among the
 rating period.                                                calendar quarters within the year in
                                                               in which it was paid.

 (1) Enter the quarter (2) List the total wages as reported on (3) For both methods, list the total        (4) Adjusted total quarterly wages after
 ending dates for the  your quarterly contribution report for  reportable wages for the seventh bi-        apportionment or deletion.
 rating period.        the quarter(s) listed in Column 1.      weekly payroll for each applicable quarter. SHADED AREA FOR 
                                                                                                           DEPARTMENTAL USE ONLY

Account  No. :_______________________________   Account name: _________________________________________________________  Date: ________________

Contact person: __ ____________________________________ Phone: ________________________ Email: _____________________________________________
Page 3                                                                                                                     Form 07-1496-03 (Rev    11/21)