Financial Advisor Reimbursement Form

Please complete this form to receive reimbursement for financial advisor services. After completing and submitting this form, please collect receipt(s) from your financial advisor identifying your name, date of consultation and total cost and submit to Amount of total reimbursement will not exceed $200 each calendar year. PLEASE NOTE: This reimbursement is a taxable benefit.

By entering my name below, I hereby certify that this expense, which does not exceed $200, was incurred on my own behalf for a consultation with a financial advisor, and I shall submit receipts for reimbursement to Human Resources within 60 days of the date on the receipt. Also, I agree that USF is not making a recommendation or acting as a fiduciary when I select an Investment Advisor or Certified Investment Professionals, nor is it responsible for the investment advice and other services provided by any Investment Advisor; I should do my own due diligence before hiring an Investment Advisor or any other financial professional; USF will have no liability or responsibility for any claims, damages, taxes, penalties, or losses arising out of or relating to my decision to engage an Investment Advisor.

Type in your full name.