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As such benefits under this Plan may be subject to withholding of Federal income tax FICA applicable state and local taxes as well as Form W-2 reporting. Please consult your Tax Advisor. Applicant s Signature Telephone 1-800-22 UAW GM 228-2946 TDD Hearing Impaired 1-800-544-1186 Mail to UAW-GM Center for Human Resources Tuition Assistance Plan PO Box 7840 Detroit MI 48207-0840 apply online at www. uawgmjas. org or fax to 313-324-5050 TIPS ON USIN.

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