Onboarding Documents For Kisha Laynette Robin

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Kisha Laynette Robinson

AGREED:
Associate Printed Name
24-May-2021 | 8:59 AM EDT

AGREED: Date:
Associate Signature
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Start
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New Health Insurance Marketplace Coverage Form Approved

Options and Your Health Coverage OMB No. 1210-0149
(expires 5-31-2020)
PART A: General Information

When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health
Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic
information about the new Marketplace and employmentbased health coverage offered by your employer.
What is the Health Insurance Marketplace?

The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The
Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible
for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance
coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?

You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or
offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on
your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible
for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be
eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does
not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your
employer that would cover you (and not any other members of your family) is more than 9.5% of your household
income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the
Affordable Care Act, you may be eligible for a tax credit. 1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-
tax basis.
How Can I Get More Information?

For more information about your coverage offered by your employer, please check your summary plan description or
contact .
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the
Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health
insurance coverage and contact information for a Health Insurance Marketplace in your area.
1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered
by the plan is no less than 60 percent of such costs.
PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an
application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered
to correspond to the Marketplace application.
3. Employer name 4. Employer Identification Number (EIN)
The TJX Companies, Inc. 042207613

\
5. Employer address 6. Employer phone number
300 Value Way, 300 – 1AN 1-888-627-6299
7. City 8. State 9. ZIP code
Marlborough MA 01752
10. Who can we contact about employee health coverage at this job?
HR XPRESS
11. Phone number (if different from above) 12. Email address
N/A
Here is some basic information about health coverage offered by this employer:
 As your employer, we offer a health plan to:
All employees. Eligible employees are:
Some
 X employees. Eligible employees are:
Eligibility requirements vary based on date of hire, location and pay status. Please refer to your
Summary Plan Description or contact HR XPRESS at 1-888-627-6299 for further information.
 With respect to dependents:

We do offer coverage. Eligible dependents are:
Please refer to your Summary Plan Description or contact HR XPRESS at 1-888-627-6299 for
further information.
We do not offer coverage.
X If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to
be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium
discount through the Marketplace. The Marketplace will use your household income, along with other factors,
to determine whether you may be eligible for a premium discount. If, for example, your wages vary from
week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly
employed mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the
employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your
monthly premiums.
The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for
employers, but will help ensure employees understand their coverage choices.
13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in
the next 3 months?
Yes (Continue)
13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the
employee eligible for coverage? (mm/dd/yyyy) (Continue)
No (STOP and return this form to employee)
14. Does the employer offer a health plan that meets the minimum value standard*?
Yes (Go to question 15) No (STOP and return form to employee)
15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't include
family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/ she
received the maximum discount for any tobacco cessation programs, and didn't receive any other discounts based on
wellness programs.
a. How much would the employee have to pay in premiums for this plan? $
b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't
know, STOP and return form to employee.
16. What change will the employer make for the new plan year?
Employer won't offer health coverage
Employer will start offering health coverage to employees or change the premium for the lowest-cost plan
available only to the employee that meets the minimum value standard.* (Premium should reflect the
discount for wellness programs. See question 15.)
a. How much would the employee have to pay in premiums for this plan? $
b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
• An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by
the plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)
ACKNOWLEDGMENT AND AUTHORIZATION

FOR BACKGROUND CHECK
All U.S. Locations
I authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the TJX
Companies (“TJX”) from a consumer reporting agency at any time after receipt of this authorization and
throughout my employment, or status as an Advisor, if applicable. For the purpose of preparing a background
check for TJX, and subject to all laws protecting my informational privacy, I hereby authorize the following to
disclose to the consumer reporting agency the information needed to compile the report: any law
enforcement agency, administrator, state or federal agency, institution, school or university (public or private),
information service bureau, employer, or insurance company. By signing below, I acknowledge the
information that can be disclosed to the consumer reporting agency, if and only as allowed by law, includes
information concerning my employment and earnings history, education, credit history, motor vehicle history,
criminal history, military service, and professional credentials and licenses.
If you reside or are applying for a position in California, Minnesota, or Oklahoma, check this box if you would
like a free copy of the report. (Hiring Manager: Send email to [email protected] if
box is checked)
Applicant’s Signature Date

X
24-May-2021 | 8:59 AM EDT
Background Information – All Applicants

Last Name Robinson __________ __ First Kisha__ ______ Middle
Laynette
Other Names/Alias _____________________________________________________________________________

Present Street Address 102RiddickLane
__________________ _ Phone Number 665-4570
___
City/State/Zip Savannah ___________
GA ________________ _________
Former Employer _______ ____ Position ________ Dates of Employment _____
Complete This Section after Applicant Accepts Conditional Offer of Employment

This information will be used for background screening purposes only and will not be used as hiring criteria.
Social Security # 224254428 ___ Date of Birth 10/09/1981 _____________
Complete This Section Only for a Position That Operates a Company Vehicle
Driver’s License # _________ __ State of Driver’s License ____
Revised 04/18 Page 1 of 1

FIELD ASSOCIATE NON-MANAGEMENT ORIENTATION CHECKLIST
TJX recognizes the importance of being a Company of Choice where every customer and Associate feels valued and finds value. The Orientation Checklist has been
developed by TJX to help ensure that all new Associates have been informed of the Company’s expectations established to promote a safe and respectful work
environment. You must read the following information carefully, and sign and date the form when you are finished. If you have any questions, please do not hesitate
to ask your Supervisor or Human Resources Business Partner.
NEW HIRE TRIAL PERIOD
I understand that I will meet with my supervisor to discuss my performance at 90 days. I also understand that my employment with the Company is at-will and that I
must satisfactorily meet all performance standards and comply with Company policies and procedures to maintain employment with TJX.
If I am a Temporary Associate, I understand that I was hired as a temporary Associate and that my employment is temporary and not expected to last more than 90 days
but may be extended to a maximum of 120 days.
VIOLATIONS THAT MAY LEAD TO IMMEDIATE TERMINATION

The following violations may lead to immediate termination at any time during employment. The following violations are only examples and do not cover
every situation.
1. VIOLENCE - Any act involving the use of physical or verbal aggression or the threat of physical aggression against any Associate, vendor, contractor, supplier,
visitor, or customer.
2. DISCRIMINATION/HARASSMENT - Any form of unwelcome verbal or physical conduct based on an individual’s race, color, ancestry, national origin, sex,
gender, gender identity or expression, sexual orientation, marital or parental status, age, religion, medical condition, pregnancy, disability, genetic information,
protected leave status, military or veteran status, political beliefs or any other protected category covered by applicable law that impacts the workplace. This
includes behavior that impacts the workplace regardless of location, including in the workplace, at Company-sponsored business and social events, and via social
media, e-mail, or text message. This also includes making employment decisions based on an individual’s membership in one or more protected categories. Refer
to the Company’s Discrimination and Harassment Free Workplace Policies for additional information.
3. RETALIATION - Taking any negative employment action against an Associate or treating an Associate less favorably because he or she has raised a good faith
concern or complaint of possible violations of the Code of Conduct, Company policies, or applicable law or because he or she has participated in an investigation
related to the concern or complaint.
4. INFORMATION SECURITY AND PRIVACY - Any violation of the Company’s Information Management Program, including the Acceptable Use Policy and
Company security and privacy policies.
5. SOCIAL MEDIA - Failure to follow the Company’s Global Social Media Policy, whether you are using social media for personal reasons or in the performance
of your authorized job duties for the Company. Examples of violations include, but are not limited to, posting messages or images that violate the Company’s
Discrimination and Harassment-Free Workplace Policies, using TJX logos in a way that suggests that you are representing the Company when you are not, or
disclosing non-public financial or operational information. Please note that even posts on private social media accounts can impact the workplace and may lead
to corrective action or immediate termination.
6. IMPROPER BEHAVIOR - Inappropriate actions or conduct, whether intentional or unintentional, that impact the workplace, such as engaging in behavior that
could be viewed as malicious, obscene, threatening, or intimidating or making or publishing statements that are reckless or knowingly false about Associates,
customers, vendors, visitors, or the Company.
7. FRATERNIZATION - Being romantically involved or having an intimate relationship with an Associate whom you either directly or indirectly supervise or for
whom you have oversight responsibility.
8. INSUBORDINATION - Refusal to follow reasonable job-related requests or instructions given by authorized management.
9. DISHONESTY - Any deliberate act which demonstrates a lack of honesty or integrity or an intent to deceive. Dishonesty may result in the loss of Company,
Associate, or third-party property, such as taking or keeping property, cash, merchandise, or lead to an improper benefit or advantage to an Associate or third
party.
10. NEGLIGENCE/VANDALISM - Causing or attempting to cause damage to or loss of Company, vendor, visitor, or Associate property, either intentionally or
through carelessness (e.g., graffiti, marking or defacing of restroom walls, damaging equipment).
11. ALCOHOL/MARIJUANA/DRUGS - Being under the influence of or impaired by alcohol, marijuana (including recreational and medical marijuana), or illegal
drugs at work, during work time, while performing work-related activities, or in a vehicle for Company business. Using, possessing, distributing, exchanging,
selling, gifting, or promoting alcohol, marijuana (including recreational and medical marijuana), or illegal drugs at work, during work time, while performing
work-related activities, or in a vehicle for Company business. Misuse of prescription or over-the-counter medications at work, during work time, while
performing work-related activities, or in a vehicle for Company business is also prohibited. Limited exchange or gifting of alcohol (for example, at the holidays)
or drinking alcohol responsibly and in moderation at certain appropriate work events is permitted.
12. SHOPLIFTER APPREHENSION – Apprehending, attempting to apprehend, or directing another Associate to apprehend a suspected shoplifter, including but
not limited to communicating with or approaching a suspected shoplifter, making physical contact with the suspected shoplifter or merchandise in their
possession, deterring or blocking a building exit, or following a suspected shoplifter after they exit the building. Only Loss Prevention Associates are permitted
to apprehend suspected shoplifters and they must act consistent with Loss Prevention Policy and Procedure.
13. IMPROPER JOB PROCEDURES - Failure to follow established job procedures.
14. FALSIFICATION OF COMPANY DOCUMENTS - Falsification or improper alteration or destruction of Company documents including, but not limited to,
the employment application, price tags, markdowns, reports, checks, expense vouchers, refunds, time capture records/reports, job-related paperwork, or any other
Company-related documents. Any Company document an Associate produces, completes, or signs must be accurate to the best of their knowledge.
Rev 02/19 Page 1 of 2

FIELD ASSOCIATE NON-MANAGEMENT ORIENTATION CHECKLIST

15. REMOVAL OF COMPANY PROPERTY, DOCUMENTS, OR INFORMATION - Removal of Company property, documents, or information from the
premises without proper authorization, including but not limited to, samples, customer or vendor lists, or other Confidential or Business information as defined in
the Information Management Program, or the unauthorized transmittal of information from such records to personal e-mail, personal computers, personal storage
devices (such as zip drives), or any third party.
16. WEAPONS - Possession of weapons on Company time or premises at any time, unless authorized by applicable state law. Associates are never permitted to
bring weapons into Company buildings.
17. SOLICITING - Soliciting, canvassing, distributing, or posting unauthorized literature in working areas or on working time or using Company resources to
solicit, canvass, distribute, or post unauthorized literature.
18. RECEIVING GIFTS - Receiving money and/or valuable gifts or entertainment from third parties in violation of the TJX Gifts and Entertainment Policy.
19. TIME CARD AND TIME-KEEPING VIOLATIONS - Improperly clocking or editing any other Associate’s time card, failing to respond to or follow up on
time-keeping system prompts, performing any “off-the-clock” work (if Non-Exempt), or instructing, requiring, or permitting any Non-Exempt Associate to
perform “off-the-clock” work in violation of the Company’s Compensation and Time-Keeping Policies.
OTHER VIOLATIONS THAT MAY LEAD TO CORRECTIVE ACTION

The following violations may lead to corrective action, up to and including termination. Repeated violations may lead to ter mination. The following
violations are only examples and do not cover every situation.
1. POOR ASSOCIATE RELATIONS/POOR CUSTOMER RELATIONS - Not treating other Associates with respect or not providing prompt, courteous, and
knowledgeable service to customers.
2. POOR PERFORMANCE - Not meeting standards in the fundamentals, methods, and procedures of job duties.
3. POOR ATTENDANCE - Arriving to work late or absences in excess of what is permitted under the Company’s Attendance Policy.
4. NO CALL NO SHOW - Failure to report to work without notifying a member of management before the beginning of scheduled shift (three consecutive
scheduled days without calling in will be considered job abandonment).
5. FAILURE TO CLOCK IN AND OUT - Failure to clock in and out of work at the beginning and end of a shift, at the beginning and end of a meal period, or at
the beginning or end of a rest break (for Associates under the age of 18 only) in violation of the Company’s Compensation and Time-Keeping Policy.
6. INAPPROPRIATE CLOTHING/FOOTWEAR - Not following the Company’s Dress Code Policy.
7. UNAUTHORIZED BREAK PERIODS - Taking breaks or lunch periods significantly longer than the time authorized without management approval or taking
lunch periods shorter than the time authorized by Company policy.
8. IMPROPER USE OF ASSOCIATE DISCOUNT - Using or lending the Associate discount card other than as outlined by Company policy.
9. SMOKING - Smoking, vaping, or using any form of tobacco in any non-designated area.
10. EXCESSIVE PERSONAL OR INAPPROPRIATE USE OF COMPANY ASSETS - Inappropriate or excessive use of Company assets including, but not
limited to, phones, computers, laptops, tablets, e-mail, and internet. Please note that inappropriate use of personal cell phones or other electronic or
communication devices, such as music devices, during work time or in work areas may also lead to corrective action.
11. EATING AND DRINKING - Consuming food and drink anywhere other than designated areas.
This Orientation Checklist has been prepared to familiarize you with certain Company expectations. While TJX believes wholeheartedly in the expectations
outlined in this Orientation Checklist, they are not terms or conditions of employment.
TJX reserves the right to modify, expand, suspend, add to, or eliminate any or all, or any part of, the expectations s et forth at any time with or without
notice. The language used does not alter at-will employment status and does not create an employment contract between TJX and any one or all of its
Associates.
This Orientation Checklist is not intended to be exhaustive. Please refer to the TJX Code of Conduct and specific Company policies and procedures for
additional information.
TEMPORARY ASSOCIATES ONLY: I ACKNOWLEDGE THAT I WAS HIRED AS A TEMPORARY ASSOCIATE AND THAT MY EMPLOYMENT IS
NOT EXPECTED TO LAST MORE THAN 90 DAYS, BUT MAY BE EXTENDED TO 120 DAYS.
I HAVE REVIEWED THIS ORIENTATION CHECKLIST AND ACKNOWLEDGE THAT I UNDERSTAND ALL EXPECTATIONS. I AGREE TO
DIRECT ANY QUESTIONS TO MY MANAGER OR HUMAN RESOURCES.
I HAVE REVIEWED THIS ORIENTATION CHECKLIST AND HAVE READ AND UNDERSTAND ALL POLICIES AND PROCEDURES OUTLINED
HEREIN.
24-May-2021 | 8:59 AM EDT
__________________________________________________
Kisha Laynette Robinson
___________________________________________________ _______________________
ASSOCIATE SIGNATURE ASSOCIATE NAME PRINT DATE

Form W-4 Employee’s Withholding Certificate OMB No. 1545-0074
2021
a Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
(Rev. December 2020)
a Give Form W-4 to your employer.
Department of the Treasury
Internal Revenue Service a Your withholding is subject to review by the IRS.
(a) First name and middle initial Last name (b) Social security number
Step 1:
Kisha L Robinson 224 25 4428
Enter Address a Does your name match the
Personal 102 Riddick Lane name on your social security
card? If not, to ensure you get
Information City or town, state, and ZIP code credit for your earnings, contact
SSA at 800-772-1213 or go to
Savannah GA 31407- www.ssa.gov.
(c) Single or Married filing separately
Married filing jointly or Qualifying widow(er)
✔ Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can
claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.
Step 2: Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse
Multiple Jobs also works. The correct amount of withholding depends on income earned from all of these jobs.
or Spouse Do only one of the following.
Works (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or
(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option
is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . a ✔
TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment
income, including as an independent contractor, use the estimator.
Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will
be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3: If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Claim
Multiply the number of qualifying children under age 17 by $2,000 a $
Dependents
Multiply the number of other dependents by $500 . . . . a $ 500
Add the amounts above and enter the total here . . . . . . . . . . . . . 3 $ 500.00
Step 4 (a) Other income (not from jobs). If you want tax withheld for other income you expect
(optional): this year that won’t have withholding, enter the amount of other income here. This may
include interest, dividends, and retirement income . . . . . . . . . . . . 4(a) $
Other
Adjustments
(b) Deductions. If you expect to claim deductions other than the standard deduction
and want to reduce your withholding, use the Deductions Worksheet on page 3 and
enter the result here . . . . . . . . . . . . . . . . . . . . . 4(b) $
(c) Extra withholding. Enter any additional tax you want withheld each pay period . 4(c) $
Step 5: Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Sign
24-May-2021 | 8:59 AM EDT
F
Here
Employee’s signature (This form is not valid unless you sign it.) Date
Employers Employer’s name and address First date of Employer identification

employment number (EIN)
Only T.J. Maxx 250 Pooler Parkway; The Village on Pooler
Parkway Pooler GA 31322 05/25/2021 04 2207613
For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2021)
Form W-4 (2021) Page 2
General Instructions Specific Instructions

Future Developments Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
For the latest information about developments related to compute your withholding.
Form W-4, such as legislation enacted after it was published,
go to www.irs.gov/FormW4. Step 2. Use this step if you (1) have more than one job at the
same time, or (2) are married filing jointly and you and your
Purpose of Form spouse both work.
Complete Form W-4 so that your employer can withhold the Option (a) most accurately calculates the additional tax
correct federal income tax from your pay. If too little is you need to have withheld, while option (b) does so with a
withheld, you will generally owe tax when you file your tax little less accuracy.
return and may owe a penalty. If too much is withheld, you If you (and your spouse) have a total of only two jobs, you
will generally be due a refund. Complete a new Form W-4 may instead check the box in option (c). The box must also
when changes to your personal or financial situation would be checked on the Form W-4 for the other job. If the box is
change the entries on the form. For more information on checked, the standard deduction and tax brackets will be
withholding and when you must furnish a new Form W-4, cut in half for each job to calculate withholding. This option
see Pub. 505, Tax Withholding and Estimated Tax. is roughly accurate for jobs with similar pay; otherwise, more
Exemption from withholding. You may claim exemption tax than necessary may be withheld, and this extra amount
from withholding for 2021 if you meet both of the following will be larger the greater the difference in pay is between the
conditions: you had no federal income tax liability in 2020 two jobs.
and you expect to have no federal income tax liability in Multiple jobs. Complete Steps 3 through 4(b) on only
2021. You had no federal income tax liability in 2020 if (1)
your total tax on line 24 on your 2020 Form 1040 or 1040-SR
F ! one Form W-4. Withholding will be most accurate if
CAUTION
you do this on the Form W-4 for the highest paying job.
is zero (or less than the sum of lines 27, 28, 29, and 30), or
(2) you were not required to file a return because your Step 3. This step provides instructions for determining the
income was below the filing threshold for your correct filing amount of the child tax credit and the credit for other
status. If you claim exemption, you will have no income tax dependents that you may be able to claim when you file your
withheld from your paycheck and may owe taxes and tax return. To qualify for the child tax credit, the child must
penalties when you file your 2021 tax return. To claim be under age 17 as of December 31, must be your
exemption from withholding, certify that you meet both of dependent who generally lives with you for more than half
the conditions above by writing “Exempt” on Form W-4 in the year, and must have the required social security number.
the space below Step 4(c). Then, complete Steps 1(a), 1(b), You may be able to claim a credit for other dependents for
and 5. Do not complete any other steps. You will need to whom a child tax credit can’t be claimed, such as an older
submit a new Form W-4 by February 15, 2022. child or a qualifying relative. For additional eligibility
requirements for these credits, see Pub. 972, Child Tax
Your privacy. If you prefer to limit information provided in Credit and Credit for Other Dependents. You can also
Steps 2 through 4, use the online estimator, which will also include other tax credits in this step, such as education tax
increase accuracy. credits and the foreign tax credit. To do so, add an estimate
As an alternative to the estimator: if you have concerns of the amount for the year to your credits for dependents
with Step 2(c), you may choose Step 2(b); if you have and enter the total amount in Step 3. Including these credits
concerns with Step 4(a), you may enter an additional amount will increase your paycheck and reduce the amount of any
you want withheld per pay period in Step 4(c). If this is the refund you may receive when you file your tax return.
only job in your household, you may instead check the box Step 4 (optional).
in Step 2(c), which will increase your withholding and
significantly reduce your paycheck (often by thousands of Step 4(a). Enter in this step the total of your other
dollars over the year). estimated income for the year, if any. You shouldn’t include
income from any jobs or self-employment. If you complete
When to use the estimator. Consider using the estimator at Step 4(a), you likely won’t have to make estimated tax
www.irs.gov/W4App if you: payments for that income. If you prefer to pay estimated tax
1. Expect to work only part of the year; rather than having tax on other income withheld from your
paycheck, see Form 1040-ES, Estimated Tax for Individuals.
2. Have dividend or capital gain income, or are subject to
additional taxes, such as Additional Medicare Tax; Step 4(b). Enter in this step the amount from the Deductions
Worksheet, line 5, if you expect to claim deductions other than
3. Have self-employment income (see below); or
the basic standard deduction on your 2021 tax return and
4. Prefer the most accurate withholding for multiple job want to reduce your withholding to account for these
situations. deductions. This includes both itemized deductions and other
Self-employment. Generally, you will owe both income and deductions such as for student loan interest and IRAs.
self-employment taxes on any self-employment income you Step 4(c). Enter in this step any additional tax you want
receive separate from the wages you receive as an withheld from your pay each pay period, including any
employee. If you want to pay these taxes through amounts from the Multiple Jobs Worksheet, line 4. Entering an
withholding from your wages, use the estimator at amount here will reduce your paycheck and will either increase
www.irs.gov/W4App to figure the amount to have withheld. your refund or reduce any amount of tax that you owe.
Nonresident alien. If you’re a nonresident alien, see Notice
1392, Supplemental Form W-4 Instructions for Nonresident
Aliens, before completing this form.
Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE
Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1 Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one
job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the
“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter
that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . . 1 $
2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and
2c below. Otherwise, skip to line 3.
a Find the amount from the appropriate table on page 4 using the annual wages from the highest
paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job
in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries
and enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . . 2a $
b Add the annual wages of the two highest paying jobs from line 2a together and use the total as the
wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower
Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount
on line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2b $
c Add the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . . 2c $
3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays
weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . . 3
4 Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this
amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional
amount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . . 4 $
Step 4(b)—Deductions Worksheet (Keep for your records.)
1 Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040)). Such deductions
may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to
$10,000), and medical expenses in excess of 7.5% of your income . . . . . . . . . . . . 1 $
{ }
• $25,100 if you’re married filing jointly or qualifying widow(er)
2 Enter: • $18,800 if you’re head of household . . . . . . . . 2 $
• $12,550 if you’re single or married filing separately
3 If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater
than line 1, enter “-0-” . . . . . . . . . . . . . . . . . . . . . . . . . . 3 $
4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other
adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information . . . . 4 $
5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . . 5 $ 0.00
Privacy Act and Paperwork Reduction Act Notice. We ask for the information You are not required to provide the information requested on a form that is
on this form to carry out the Internal Revenue laws of the United States. Internal subject to the Paperwork Reduction Act unless the form displays a valid OMB
Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to control number. Books or records relating to a form or its instructions must be
provide this information; your employer uses it to determine your federal income retained as long as their contents may become material in the administration of
tax withholding. Failure to provide a properly completed form will result in your any Internal Revenue law. Generally, tax returns and return information are
being treated as a single person with no other entries on the form; providing confidential, as required by Code section 6103.
fraudulent information may subject you to penalties. Routine uses of this The average time and expenses required to complete and file this form will vary
information include giving it to the Department of Justice for civil and criminal depending on individual circumstances. For estimated averages, see the
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and instructions for your income tax return.
possessions for use in administering their tax laws; and to the Department of
Health and Human Services for use in the National Directory of New Hires. We If you have suggestions for making this form simpler, we would be happy to hear
may also disclose this information to other countries under a tax treaty, to federal from you. See the instructions for your income tax return.
and state agencies to enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism.

Married Filing Jointly or Qualifying Widow(er)
Higher Paying Job Lower Paying Job Annual Taxable Wage & Salary
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $0 $190 $850 $890 $1,020 $1,020 $1,020 $1,020 $1,020 $1,100 $1,870 $1,870
$10,000 - 19,999 190 1,190 1,890 2,090 2,220 2,220 2,220 2,220 2,300 3,300 4,070 4,070
$20,000 - 29,999 850 1,890 2,750 2,950 3,080 3,080 3,080 3,160 4,160 5,160 5,930 5,930
$30,000 - 39,999 890 2,090 2,950 3,150 3,280 3,280 3,360 4,360 5,360 6,360 7,130 7,130
$40,000 - 49,999 1,020 2,220 3,080 3,280 3,410 3,490 4,490 5,490 6,490 7,490 8,260 8,260
$50,000 - 59,999 1,020 2,220 3,080 3,280 3,490 4,490 5,490 6,490 7,490 8,490 9,260 9,260
$60,000 - 69,999 1,020 2,220 3,080 3,360 4,490 5,490 6,490 7,490 8,490 9,490 10,260 10,260
$70,000 - 79,999 1,020 2,220 3,160 4,360 5,490 6,490 7,490 8,490 9,490 10,490 11,260 11,260
$80,000 - 99,999 1,020 3,150 5,010 6,210 7,340 8,340 9,340 10,340 11,340 12,340 13,260 13,460
$100,000 - 149,999 1,870 4,070 5,930 7,130 8,260 9,320 10,520 11,720 12,920 14,120 15,090 15,290
$150,000 - 239,999 2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,830 14,030 15,230 16,190 16,400
$240,000 - 259,999 2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,830 14,030 15,270 17,040 18,040
$260,000 - 279,999 2,040 4,440 6,500 7,900 9,230 10,430 11,630 12,870 14,870 16,870 18,640 19,640
$280,000 - 299,999 2,040 4,440 6,500 7,900 9,230 10,470 12,470 14,470 16,470 18,470 20,240 21,240
$300,000 - 319,999 2,040 4,440 6,500 7,940 10,070 12,070 14,070 16,070 18,070 20,070 21,840 22,840
$320,000 - 364,999 2,720 5,920 8,780 10,980 13,110 15,110 17,110 19,110 21,190 23,490 25,560 26,860
$365,000 - 524,999 2,970 6,470 9,630 12,130 14,560 16,860 19,160 21,460 23,760 26,060 28,130 29,430
$525,000 and over 3,140 6,840 10,200 12,900 15,530 18,030 20,530 23,030 25,530 28,030 30,300 31,800
Single or Married Filing Separately
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $440 $940 $1,020 $1,020 $1,410 $1,870 $1,870 $1,870 $1,870 $2,030 $2,040 $2,040
$10,000 - 19,999 940 1,540 1,620 2,020 3,020 3,470 3,470 3,470 3,640 3,840 3,840 3,840
$20,000 - 29,999 1,020 1,620 2,100 3,100 4,100 4,550 4,550 4,720 4,920 5,120 5,120 5,120
$30,000 - 39,999 1,020 2,020 3,100 4,100 5,100 5,550 5,720 5,920 6,120 6,320 6,320 6,320
$40,000 - 59,999 1,870 3,470 4,550 5,550 6,690 7,340 7,540 7,740 7,940 8,140 8,150 8,150
$60,000 - 79,999 1,870 3,470 4,690 5,890 7,090 7,740 7,940 8,140 8,340 8,540 9,190 9,990
$80,000 - 99,999 2,000 3,810 5,090 6,290 7,490 8,140 8,340 8,540 9,390 10,390 11,190 11,990
$100,000 - 124,999 2,040 3,840 5,120 6,320 7,520 8,360 9,360 10,360 11,360 12,360 13,410 14,510
$125,000 - 149,999 2,040 3,840 5,120 6,910 8,910 10,360 11,360 12,450 13,750 15,050 16,160 17,260
$150,000 - 174,999 2,220 4,830 6,910 8,910 10,910 12,600 13,900 15,200 16,500 17,800 18,910 20,010
$175,000 - 199,999 2,720 5,320 7,490 9,790 12,090 13,850 15,150 16,450 17,750 19,050 20,150 21,250
$200,000 - 249,999 2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,820 20,930 22,030
$250,000 - 399,999 2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,820 20,930 22,030
$400,000 - 449,999 2,970 5,880 8,260 10,560 12,860 14,620 15,920 17,220 18,520 19,910 21,220 22,520
$450,000 and over 3,140 6,250 8,830 11,330 13,830 15,790 17,290 18,790 20,290 21,790 23,100 24,400
Head of Household
Annual Taxable $0 - $10,000 - $20,000 - $30,000 - $40,000 - $50,000 - $60,000 - $70,000 - $80,000 - $90,000 - $100,000 - $110,000 -
Wage & Salary 9,999 19,999 29,999 39,999 49,999 59,999 69,999 79,999 89,999 99,999 109,999 120,000
$0 - 9,999 $0 $820 $930 $1,020 $1,020 $1,020 $1,420 $1,870 $1,870 $1,910 $2,040 $2,040
$10,000 - 19,999 820 1,900 2,130 2,220 2,220 2,620 3,620 4,070 4,110 4,310 4,440 4,440
$20,000 - 29,999 930 2,130 2,360 2,450 2,850 3,850 4,850 5,340 5,540 5,740 5,870 5,870
$30,000 - 39,999 1,020 2,220 2,450 2,940 3,940 4,940 5,980 6,630 6,830 7,030 7,160 7,160
$40,000 - 59,999 1,020 2,470 3,700 4,790 5,800 7,000 8,200 8,850 9,050 9,250 9,380 9,380
$60,000 - 79,999 1,870 4,070 5,310 6,600 7,800 9,000 10,200 10,850 11,050 11,250 11,520 12,320
$80,000 - 99,999 1,880 4,280 5,710 7,000 8,200 9,400 10,600 11,250 11,590 12,590 13,520 14,320
$100,000 - 124,999 2,040 4,440 5,870 7,160 8,360 9,560 11,240 12,690 13,690 14,690 15,670 16,770
$125,000 - 149,999 2,040 4,440 5,870 7,240 9,240 11,240 13,240 14,690 15,890 17,190 18,420 19,520
$150,000 - 174,999 2,040 4,920 7,150 9,240 11,240 13,290 15,590 17,340 18,640 19,940 21,170 22,270
$175,000 - 199,999 2,720 5,920 8,150 10,440 12,740 15,040 17,340 19,090 20,390 21,690 22,920 24,020
$200,000 - 249,999 2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,880 24,980
$250,000 - 349,999 2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,880 24,980
$350,000 - 449,999 2,970 6,470 9,000 11,390 13,690 15,990 18,290 20,040 21,340 22,640 23,900 25,200
$450,000 and over 3,140 6,840 9,570 12,160 14,660 17,160 19,660 21,610 23,110 24,610 26,050 27,350
TJX Associate Assistance Program

(TAAP)
Summary Plan Description
September 1, 2019
(Revised March 27, 2020)
This Summary Plan Description summarizes the TJX Associate Assistance Program (TAAP) available under The
TJX Companies, Inc. Welfare Benefits Plan.
Introduction
Introduction
This Summary Plan Description (“SPD”) describes the benefits offered by TAAP under The TJX Companies, Inc.,
Welfare Benefits Plan (the “Plan”). The Plan has been established for the exclusive benefit of eligible Associates and
their eligible spouses and dependent children of the operating divisions, subsidiaries and the corporate office of The
TJX Companies, Inc. (also referenced as “Company” in this SPD).
TAAP is administered by Crisis Management Group, Inc. (dba “CMG Associates”) on behalf of The TJX Companies,
Inc.
To Access TAAP (available 24 hours a day)
Website www.taaptjx.com*
Username: TJX
Password: TAAP
*Available in English and Spanish. (Disponible en inglés y español.)
Phone 866-589-2347
TTY 866-228-2809
Questions
For questions about TAAP, call the toll-free number, 866-589-2347. For questions about the Welfare Benefits Plan and
Company benefits generally, call HR XPRESS at 1-888-627-6299, or your Benefits Department, Monday through
Friday, 9:00 a.m. to 6:00 p.m. (Eastern Time).
Este documento contiene un resumen en inglés de sus derechos y beneficios bajo el Plan. Si tiene alguna
dificultad entendiendo cualquier parte de este documento puede llamar al Administrador del Plan al 1-866-589-
2347 para asistencia.
1
The TJX Associate Assistance Program (TAAP)
Eligibility
Who is Eligible for TAAP?
All Associates employed by the Company in the United States and their family members are eligible for the services
provided by TAAP.
When is Eligibility Effective?

You and your family members are automatically eligible to participate in TAAP when you are hired by the Company.
When Does Eligibility End?

Coverage under TAAP will end 60 days after your termination of employment with the Company. If you would like
coverage to extend beyond that point, you have the right to elect COBRA continuation of coverage. See “COBRA” on
page 3 for more details.
About TAAP
TAAP is a voluntary program provided to TJX Associates and family members and administered by CMG Associates.
TAAP is a free and confidential support program to help Associates and their families balance their work, family and
personal life. Available 24 hours a day and in multiple languages, TAAP provides information, work-life resources,
referrals, in the moment counseling, and counseling referrals.
TAAP provides assistance and guidance on issues that matter to you:

 Balancing work and home life
 Relationships
 Stress
 Grief, trauma, and loss
 Anxiety and depression
 Major mental health concerns
 Child care and elder care resources
 Legal resources and referrals
 Debt management and budgeting
 Substance abuse treatment referrals
 Bullying
 Relocation
 Life transitions
 Immigration
 Domestic and family issues
TAAP provides up to six (6) free counseling sessions with a licensed mental health provider in your area. These
counseling sessions can be face to face, or by telephone. (TAAP will always try to match you to a provider who takes
your health insurance so that you can more easily continue counseling beyond the initial six sessions. You are
responsible for all fees and/or copayments as designated by your health insurance coverage.) TAAP also provides
resource and referral information for numerous work-life issues.
2
More details about the services provided under TAAP can be found on the TAAP website at the address below.
How to Contact TAAP
Visit the TAAP website www.taaptjx.com (Username: TJX | Password: TAAP)
To talk with a TAAP counselor, call 866-589-2347.
TTY Services: 866-228-2809
Confidentiality
Your discussions with TAAP counselors are completely confidential. No one will know when you contact TAAP unless
you choose to tell someone or give written permission to release information. Contact with TAAP will not jeopardize
current employment or advancement opportunities.
Complaint Process & Claims Procedure

You are encouraged to call TAAP at 617-969-7600 to discuss all complaints. While you are encouraged to call with any
complaints, you may also choose to send a written complaint to the address below.
Crisis Management Group Associates, Inc.

381 Elliot Street, Suite 180L
Newton, MA 02464
In the unlikely event your claim for benefits under TAAP is denied in whole or in part, CMG Associates will provide
notice of the decision on such claim and any right to appeal the decision.
COBRA
TAAP coverage continues for all participants for 60 days following termination of employment. If you would like
coverage to extend beyond that point, you have the right to elect continuation of coverage under COBRA (the
Consolidated Omnibus Budget Reconciliation Act).
What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of TAAP coverage when it would otherwise end because of a life
event. This is also called a “qualifying event.” After a qualifying event, COBRA continuation coverage must be offered
to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified
beneficiaries if TAAP coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified
beneficiaries who elect COBRA continuation coverage of TAAP aren’t required to pay for COBRA continuation
coverage.
If you’re an Associate, you’ll become a qualified beneficiary when you lose your TAAP coverage under the Plan 60
days after your termination of employment with the Company.
If you’re the spouse of an Associate, you’ll become a qualified beneficiary if you lose your TAAP coverage under the
Plan because of the following qualifying events:
 Your spouse dies;
 Your spouse’s employment ends for any reason other than his or her gross misconduct; or
 You become divorced or legally separated from your spouse.
3
Your dependent children will become qualified beneficiaries if they lose TAAP coverage under the Plan because of the
following qualifying events:
 The parent-employee dies;
 The parent-employee’s employment ends for any reason other than his or her gross misconduct;
 The parents become divorced or legally separated; or
 The child stops being eligible for TAAP coverage under the Plan as a “dependent child.”
When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage for TAAP to qualified beneficiaries only if you notify the Company
within 60 days after the qualifying event occurs. Please call HR XPRESS at 888-627-6299 to elect COBRA
continuation coverage for TAAP.
How is COBRA continuation coverage provided?

Once the Company receives notice that a qualifying event has occurred, COBRA continuation coverage will be
available to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect
COBRA continuation coverage. Covered Associates may elect COBRA continuation coverage on behalf of their
spouses and children.
COBRA continuation coverage for TAAP is a temporary continuation of coverage that generally lasts for 18 months
due to employment termination. Certain qualifying events, or a second qualifying event during the initial period of
coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability extension of 18-month period of COBRA continuation coverage. If you or anyone in your family covered
under the Plan is determined by Social Security to be disabled and you notify the Company in a timely fashion, you and
your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for TAAP, for
a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA
continuation coverage for TAAP and must last at least until the end of the 18-month period of COBRA continuation
coverage for TAAP. You must notify the Company by calling HR XPRESS at 888-627-6299 if this disability extension
applies.
Second qualifying event extension of 18-month period of continuation coverage. If your family experiences another
qualifying event during the 18 months of COBRA continuation coverage for TAAP, the spouse and dependent children
in your family can get up to 18 additional months of COBRA continuation coverage for TAAP, for a maximum of 36
months, if the Company is properly notified about the second qualifying event. This extension may be available to the
spouse and any dependent children getting COBRA continuation coverage for TAAP if the associate or former
Associate dies; gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a
dependent child. This extension is only available if the second qualifying event would have caused the spouse or
dependent child to lose TAAP coverage under the Plan had the first qualifying event not occurred.
If you have questions

Questions concerning the Plan or your COBRA continuation coverage rights for TAAP should be addressed HR XPRESS
at 888-627-6299. For more information about your rights under the Employee Retirement Income Security Act (ERISA),
including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact
the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration
(EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices
are available through EBSA’s website.)
Keep the Plan informed of address changes
To protect your family’s rights, let the Company know about any changes in the addresses of family members. You
should also keep a copy, for your records, of any notices you send to the Company related to COBRA continuation
coverage for TAAP.
4
Notice of Privacy Practices

GROUP HEALTH PLANS OF THE TJX COMPANIES, INC.
Effective date: September 23, 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The group health plans sponsored by The TJX Companies, Inc. (“TJX”) are required to provide you with this notice
regarding your rights and our policies and procedures regarding your individually identifiable health information
(referred to in this notice as “Protected Health Information” or “PHI”) and to abide by the terms of this notice as it may
be updated from time to time.
This notice describes the privacy practices of TJX’s group health plans (collectively, “we,” “us” or the “Plan”). It is
important to note that these rules apply to the Plan, not to TJX as an employer.
We are required by law to:
 Maintain the privacy of your PHI;

 Give you this notice of our legal duties and privacy practices with respect to that information;
 Abide by the terms of our privacy notice that is currently in effect; and
 Notify you in the event of a breach of your unsecured PHI.
This notice tells you about the ways we may use and disclose PHI about you. It also describes your rights and certain
obligations we have with respect to your PHI. If you are covered by an insured health care option under the Plan, you
will also receive a separate notice from your insurer or HMO. Your personal doctor or health care provider may have
different policies or notices regarding their use and disclosure of your medical information.
How to Contact Us
If you have any questions or would like further information about this notice, you can either write to or call:
The TJX Companies, Inc.

Attn: HIPAA Privacy Officer
Compliance
770 Cochituate Rd.
Framingham, MA 01701
774-308-3799
How We May Use and Disclose Health Information about You
We describe below reasons we may use and disclose health information about you. For each category, we explain what
we mean. For some categories, we also give you examples. Please note that this notice does not list every use or
disclosure; instead, it gives examples of the most common uses and disclosures.
Treatment. We may use or disclose your PHI to health care providers in coordinating or managing your health care
and related services. Health care providers include physicians, hospitals and other health caregivers who provide
services to you. For example, we may use or disclose your PHI for coordinating your health care or referring you to
another provider for care.
Payment. We may use and disclose PHI submitted by you or your health care provider in making determinations
concerning coverage or eligibility, such as when itemized medical bills are submitted to the Plan or its third party
administrator for reimbursement. The submitted medical bills usually will include information that identifies you, as
well as the services or procedures provided and supplies used. We may, for example, use information from your health
care provider to process your claim.
5
Health Care Operations. We may use and disclose your PHI for plan administration purposes. We may use your PHI
to assess the quality of care and outcome of services provided to you and others like you in an effort to improve the
quality of health care provided. Your information could be used, for example, to assist in the evaluation of one or more
service providers who support the Plan. Other health care operation activities include responding to your questions,
grievance or external review programs, disease management, case management, care coordination, detection and
investigation of fraud, auditing, underwriting and ratemaking, and other general administrative activities. We will not
use or disclose your genetic information for underwriting.
Where Required by Law or for Public Health Activities. We may disclose PHI when required by federal, state or
local law. Examples of such mandatory disclosures include notifying state or local health authorities regarding
particular communicable diseases, or providing PHI to a governmental agency or regulator with health care oversight
responsibilities. We may also release PHI to a coroner or medical examiner to assist in identifying a deceased individual
or to determine the cause of death.
To Avert a Serious Threat to Health or Safety. We may disclose PHI to avert a serious threat to someone’s health or
safety. We may also disclose PHI to federal, state or local agencies engaged in disaster relief as well as to private disaster
relief or disaster assistance agencies to allow such entities to carry out their responsibilities in specific disaster situations.
For Law Enforcement or Specific Government Functions. We may disclose PHI in response to a request by a law
enforcement official made through a court order, subpoena, warrant, summons or similar process. We may disclose PHI
about you to federal officials for intelligence, counterintelligence, and other national security activities as authorized by law.
When Requested as Part of a Regulatory or Legal Proceeding. If you or your estate is involved in a lawsuit or
dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about
you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but
only if efforts have been made to tell you about the request or to obtain an order protecting the PHI requested. We may
disclose PHI to any governmental agency or regulator with whom you have filed a complaint or as part of a regulatory
agency examination.
Health-Related Benefits and Services. We may use and disclose health information about you to tell you about
health-related benefits and services that may be of interest to you.
Victims of Abuse, Neglect or Domestic Violence. Under certain circumstances, we may disclose to the appropriate
government authority health information about an individual whom we believe is a victim of abuse, neglect or domestic
violence. We will make this disclosure only (i) if you agree, (ii) to the extent required by law, or (iii) to the extent
authorized by law and only if we believe the disclosure is necessary to prevent serious harm.
For Organ, Eye or Tissue Donation Purposes. We may use or disclose your PHI to organ procurement organizations
or other entities engaged in the procurement, banking or transplantation of cadaveric organs, eyes or tissue for the
purpose of facilitating organ, eye or tissue donation and transplantation.
For Research Purposes. Under certain circumstances, we may use or disclose your PHI for research.
For Workers’ Compensation Purposes. We may disclose your PHI as authorized by and to the extent necessary to
comply with laws relating to workers’ compensation or other similar programs established by law that provide benefits
for work-related injuries or illness without regard to fault.
Other Uses and Disclosures of Protected Health Information
We may disclose to one of your family members, a relative, a close personal friend or any other person identified by
you, PHI that is directly relevant to the person’s involvement with your care or payment related to your care. In
addition, we may use or disclose PHI to notify a member of your family, your personal representative, another person
responsible for your care, or certain disaster relief agencies of your location, general condition, or death. You have the
right to agree or object to such disclosures. If you are incapacitated, there is an emergency, or you are not present, the
Plan will do what in its judgment is in your best interest regarding such disclosure and will disclose only the
information that is directly relevant to the person’s involvement with your health care. In addition, the Plan may
disclose your PHI to the Plan’s sponsor, which is TJX, for plan administration. TJX agrees not to use or disclose your
PHI other than as permitted or required by the Plan documents or by law.
6
Except for the situations described above, we will not use or disclose your PHI without your prior written authorization
to release such information. Your written authorization is required for most uses and disclosures of psychotherapy
notes, uses and disclosures of PHI for marketing purposes and disclosures that are a sale of PHI. You also may revoke
your authorization at any time (except to the extent the Plan has relied on your authorization) by submitting a written
revocation to the contact listed in the section above entitled “How to Contact Us.”
If a stricter privacy law applies, we will comply with the stricter standard.
Your Rights
You have the following rights with respect to your PHI:
Right of Access. You may inspect and request a copy of certain PHI we have about you. We have forms for such
requests. You may obtain the appropriate form from the contact person listed in this notice. These requests must be
made in writing and must be directed to the contact person listed in this notice. We will provide a copy in a format you
request if it is readily producible. If not readily producible, we will provide the information in hard-copy format or
another format that is mutually agreeable. We may charge a reasonable, cost-based fee.
The Plan will attempt to respond to your request within 30 days if the PHI is located on site, and within 60 days if it is
located off site at another facility. If the Plan needs additional time to respond, the Plan will notify you in writing before
the end of the respective time periods indicated above to explain the reason for the delay and when you can expect to
have a final answer to your request.
Under certain limited circumstances, the Plan may deny your request to inspect or obtain a copy of your PHI. If the Plan
denies part of or your entire request, the Plan will provide a written denial that explains the reasons for doing so, a
complete description of your rights to have that decision reviewed, and how you can exercise those rights. The Plan will
also include information on how to file a complaint with the Plan or with the Secretary of the Department of Health and
Human Services (“HHS”). If the Plan has grounds to deny your access to only part of the PHI requested, the Plan will
do its best to provide you with access to the rest of the information after excluding the parts the Plan cannot let you
inspect or copy.
Right to Amend. If you believe that PHI we have about you is incorrect or incomplete, you may ask us to amend the
information. Such requests must be made in writing on the form available for this purpose, and must include a reason to
support the request. You may obtain the appropriate form from the contact person listed in this notice. Under some
circumstances, we may deny such a request, but you are entitled to a written response within 60 days of our receipt of
your written request. If the Plan denies part or all of your request, the Plan will provide a written notice that explains the
reasons for doing so. If you disagree with our decision, you will have an opportunity to submit a statement explaining
your disagreement, which the Plan will append to or otherwise link to the PHI that is the subject of the amendment
request. The Plan will also include information on how to file a complaint with the Plan or the Secretary of HHS.
Right to Request Restrictions. You may request that we restrict uses or disclosures of certain PHI about you to carry
out treatment, payment, or health care operations. We may not (and are not required to) agree to requested restrictions.
We will not use or disclose any PHI about you in violation of any restrictions that we agree to other than in providing
emergency treatment.
Confidential Communications: Alternative Means, Alternative Locations. You may ask to receive communications
of PHI by alternative means or at an alternative location. We will accommodate all reasonable requests, and must say
“yes” if you tell us you would be in danger if we do not. You must provide this type of request to us in writing and
provide an alternative method of contact or alternative address. If there will be a fee for this service, we will provide an
estimate of the fee in advance and ask that you provide information as to how payment will be handled.
Accounting of Disclosures. You have a right to receive an accounting of disclosures we have made of PHI about you
(except for disclosures to carry out treatment, payment, health care operations, and certain other disclosures) for the six
years prior to the date you request the accounting. The first such accounting we provide within any 12 month period will
be without charge to you. We may charge a reasonable, cost-based fee for each subsequent request for an accounting
within a 12-month period. We will notify you in advance of this fee.
7
The Plan will attempt to respond to your request for an accounting within 60 days. If the Plan needs additional time to
prepare the accounting you have requested, the Plan will notify you in writing about the reason for the delay and the
date when you can expect to receive the accounting. In some instances, the Plan may have to delay providing you with
the accounting without notifying you because a law enforcement official or government agency has asked the Plan to do
so.
If you request an accounting of disclosures, the Plan may elect to provide either (1) an accounting of disclosures of PHI
made by the Plan and any business Associates acting on its behalf; or (2) an accounting of disclosures made by the Plan
and a list of all business Associates acting on behalf of the Plan, including contact information for such business
Associates.
Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is
your legal guardian, that person can exercise your rights and make choices about your health information. A written
notice or authorization with any supporting documents must be provided to the Plan so we can make sure the person has
the authority and can act for you before we take any action.
Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may ask us to give you a
copy of the notice at any time. Even if you have agreed to receive the notice electronically, you may still obtain a paper
copy. To obtain a paper copy, please contact us using the contact information provided above.
Changes to This Notice
We reserve the right to change the terms of this notice and to make the changed notice provisions effective for all PHI
we have about you or create or receive in the future. We will promptly revise, post, and distribute a revised notice
whenever there is a material change to the uses or disclosures, your rights, our legal duties, or other privacy practices
discussed in this notice. Our privacy notice will contain on the first page the date on which the notice was last updated.
Complaints
If you have any complaints about your privacy rights or how your PHI has been used or disclosed, you may file a
complaint with us by contacting:

Attn: HIPAA Privacy Officer
Compliance
770 Cochituate Rd.
774-308-3799
You may also file a written complaint with the U.S. Department of Health and Human Services by sending a letter to
Hubert H. Humphrey Building, 200 Independence Avenue, SW, Washington D.C. 20201.
The privacy of your health information is important to us. We will not retaliate against you in any way if you choose to
file a complaint.
8
ERISA Information
ERISA Information
Plan Name
The TJX Companies, Inc. Welfare Benefits Plan
For
The TJX Companies, Inc., The Marmaxx Group, T.J. Maxx, Marshalls, HomeGoods, Homesense and Sierra.
Employer Identification Number (E.I.N.)
04-2207613
Plan Sponsor

770 Cochituate Rd.
888-627-6299
Name, Address, Zip Code and Telephone Number of Plan Administrator
The administrator of TAAP is Crisis Management Group, Inc.
Crisis Management Group, Inc.

Newton, MA 02464
617-969-7600
Type of Plan and Plan Number
The Plan is a welfare benefits plan offering employee assistance benefits. The plan number is 502.
Financial Records
The financial records of the Plan are kept on the Company’s fiscal year.
Agent for Service of Legal Process
Corporate Counsel
770 Cochituate Rd.
888-627-6299
Plan Status
This Summary Plan Description reflects the status of TAAP as of September 1, 2019.
Who Pays for the Plan
The Company pays for the benefits offered under TAAP.
9
ERISA Information
Where to Send Claims

Crisis Management Group, Inc.
Newton, MA 02464
617-969-7600
Right to Appeal
Claim denials occur only when the claim is judged not to be in accordance with the provisions of TAAP. If a claim for
benefits is denied, in whole or in part, CMG will provide you with written notification and information about your right
to appeal.
Discretionary Authority of Fiduciaries
To the fullest extent permitted by law, the Company and other Plan fiduciaries have the discretion to determine all
matters relating to eligibility, coverage, or benefits under the Plan and the Company and other Plan fiduciaries have the
discretion to determine all matters relating to the interpretation and operation of the Plan. Any determination by the
Company and/or other Plan fiduciary is final and binding, in the absence of clear and convincing evidence that the
Company and/or other Plan fiduciary acted arbitrarily and capriciously.
Plan Amendment and Termination – No Vesting
The TJX Companies, Inc., has established the Plan with the expectation that it will be continued indefinitely. The TJX
Companies, Inc., however, reserves the right to amend, modify or terminate the Plan, or any part of the Plan, by a
written instrument executed by a duly authorized officer of The TJX Companies, Inc. Upon execution of such
instrument, such instrument will become effective in accordance with its terms as to all Plan Associates and all persons
having or claiming any interest hereunder. There are no vested benefits under the Plan.
Your ERISA Rights

Statement of ERISA Rights
As a participant in the Plan you are entitled to certain rights and protections under the Employee Retirement Income
Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:
Receive Information about the Plan and Benefits

 Examine, free of charge, at the plan administrator’s office and at other specified locations, all documents governing
the plans, including insurance contracts and a copy of the latest annual reports (Form 5500 series) filed by the plans
with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security
Administration. These documents are also available for review through HR XPRESS.
 Obtain, upon written request to the plan administrator, copies of documents governing the operation of the plans,
including insurance contracts and copies of the latest annual report (Form 5500 series) and updated summary plan
descriptions. The administrator may charge a reasonable fee for copies.
 Receive a summary of a plan’s annual financial reports. The plan administrator is required by law to furnish each
participant a copy of these summary annual reports.
Prudent Actions by Plan Fiduciaries
In addition to establishing participants’ rights, ERISA imposes duties upon the people responsible for the operation of
an employee benefits plan. These persons are called fiduciaries. Plan fiduciaries must operate a plan prudently and in
the interest of you and other plan participants and beneficiaries. Fiduciaries who violate ERISA may be removed and
required to make good any losses they have caused a plan.
No one, including the Plan Sponsor, may fire you or otherwise discriminate against you in any way to prevent you from
obtaining a plan benefit or exercising your rights under ERISA.
10
ERISA Information
Enforce Your Rights
Under ERISA, there are steps you can take to enforce your rights. For instance, if any Plan materials you’ve requested
are not received within 30 days of your request, you may file a suit in a federal court. The court may require the plan
administrator to pay up to $110 for each day’s delay until you receive the materials unless the materials were not sent
for reasons beyond the control of the plan administrator.
If you have a claim for benefits that is denied or ignored, in whole or in part, you have a right to know why it was
denied or ignored, to obtain copies (without charge) of documents relating to the decision, and to appeal any denial
within certain timeframes. You also have the right to file suit in a federal or state court. In addition, if you disagree with
a plan’s decision or lack thereof concerning the qualified status of a domestic relations order or a medical child support
order, you may file suit in federal court. If plan fiduciaries misuse a plan’s money or you are discriminated against for
asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal
court. If you are successful in your suit, the court may order the person you have sued to pay court costs and legal fees.
If you lose, the court may order you to pay the costs and fees if, for example, it finds your claim is frivolous.
Assistance with Your Questions
If you have any questions about a benefit plan, contact the plan administrator. If you have any questions about this
statement or about your rights under ERISA, or if you need assistance in obtaining documents from the plan
administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department
of Labor, listed in your telephone directory. You may also contact the Division of Technical Assistance and Inquiries,
Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue, N.W., Washington,
D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling
the Publications Hotline at the Employee Benefits Security Administration.
A final word:
This SPD has attempted to describe the Company’s benefit plans in an accurate and understandable manner and in accordance with
the official Plan documents. The official Plan documents include, but are not limited to, as applicable, insurance company or third
party administrator contracts, insurance company or third party administrator certificates of coverage and other benefit descriptions
prepared by an insurance company or by a third party administrator, in each case with respect to the Plan. However, sometimes errors
occur, particularly where benefits change. If any conflict arises between this SPD and the official Plan documents, the official Plan
documents will control. You will not gain any rights or benefits because of any provision herein that is a misstatement or a mistake or
does not accurately reflect the terms of the official Plan documents as then in effect.
11
DISCLOSURE REGARDING
BACKGROUND INVESTIGATION
All U.S. Locations
The TJX Companies, Inc. (“the Company”) may obtain information about you from a third party consumer
reporting agency for employment purposes. Thus, you may be the subject of a “consumer report.” If you
are hired, or if you already work for the Company, the Company may order additional reports on you for
employment purposes.
The Company may order an “investigative consumer report.” Such reports typically include information
from personal interviews, most commonly from an applicant’s prior employers and references.
The consumer report may include information about your character, general reputation, personal
characteristics, and/or mode of living. These reports may contain information regarding your criminal
history, Social Security number verification, motor vehicle records (“driving records”), verification of your
education or employment history, or other background checks. Information may be obtained from private and
public record sources, and for investigative consumer reports, from personal interviews as noted above.
You have the right to request more information about the nature and scope of an investigative consumer
report, if any, by contacting TJX Background Screening at 508-390-2890.
24-May-2021 | 8:59 AM E
Applicant’s Signature: ________________________________ Date: ____________
(Must be signed by parent or guardian if applicant is under the age of 18)
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK.

Form G-4 (Rev. 02/15/19)
STATE OF GEORGIA EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE

1a. YOUR FULL NAME 1b. YOUR SOCIAL SECURITY NUMBER
Kisha Laynette Robinson 224-25-4428
2a. HOME ADDRESS (Number, Street, or Rural Route) 2b. CITY, STATE AND ZIP CODE
102 Riddick Lane Savannah GA 31407
PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING LINES 3 – 8
3. MARITAL STATUS
(If you do not wish to claim an allowance, enter “0” in the brackets beside your marital status.)
A. Single: Enter 0 or 1...........................................[ ] 4. DEPENDENT ALLOWANCES [ ]
B. Married Filing Joint, both spouses working:
Enter 0 or 1 ..................................................[ ]
C. Married Filing Joint, one spouse working: 5. ADDITIONAL ALLOWANCES [ ]
Enter 0 or 1 or 2 ...........................................[ ] (worksheet below must be completed)
D. Married Filing Separate:
Enter 0 or 1 ..................................................[ ]
E. Head of Household: 6. ADDITIONAL WITHHOLDING $____________
Enter 0 or 1 ..................................................[ 0 ]
WORKSHEET FOR CALCULATING ADDITIONAL ALLOWANCES
(Must be completed in order to enter an amount on step 5)
1. COMPLETE THIS LINE ONLY IF USING STANDARD DEDUCTION:
Yourself: Age 65 or over Blind
Spouse: Age 65 or over Blind Number of boxes checked _____ x 1300...............$______________
2. ADDITIONAL ALLOWANCES FOR DEDUCTIONS:
0
A. Federal Estimated Itemized Deductions (If Itemizing Deductions)............................. $______________
B. Georgia Standard Deduction (enter one): Single/Head of Household $4,600
Each Spouse $3,000 $______________
C. Subtract Line B from Line A (If zero or less, enter zero)....................................................................$______________
D. Allowable Deductions to Federal Adjusted Gross Income .................................................................$______________
E. Add the Amounts on Lines 1, 2C, and 2D ..........................................................................................$______________
F. Estimate of Taxable Income not Subject to Withholding ...................................................................$______________
G. Subtract Line F from Line E (if zero or less, stop here)......................................................................$______________
H. Divide the Amount on Line G by $3,000. Enter total here and on Line 5 above ................................ ______________
(This is the maximum number of additional allowances you can claim. If the remainder is over $1,500 round up)
E
7. LETTER USED (Marital Status A, B, C, D, or E) ___________ 0
TOTAL ALLOWANCES (Total of Lines 3 - 5) ___________
(Employer: The letter indicates the tax tables in Employer’s Tax Guide)
8. EXEMPT: (Do not complete Lines 3 - 7 if claiming exempt) Read the Line 8 instructions on page 2 before completing this section.
a) I claim exemption from withholding because I incurred no Georgia income tax liability last year and I do not expect to
have a Georgia income tax liability this year. Check here
b) I certify that I am not subject to Georgia withholding because I meet the conditions set forth under the Servicemembers
Civil Relief Act as provided on page 2. My state of residence is ________________. My spouse’s (servicemember) state
of residence is ________________ . The states of residence must be the same to be exempt. Check here
I certify under penalty of perjury that I am entitled to the number of withholding allowances or the exemption from withholding status
claimed on this Form G-4. Also, I authorize my employer to deduct per pay period the additional amount listed above.
24-May-2021 | 8:59 AM EDT
Employee’s Signature________________________________________________________ Date _________________
Employer: Complete Line 9 and mail entire form only if the employee claims over 14 allowances or exempt from withholding.
If necessary, mail form to: Georgia Department of Revenue, Withholding Tax Unit, 1800 Century Blvd NE, Suite 8200, Atlanta, GA 30345
9. EMPLOYER’S NAME AND ADDRESS: 04-2207613
EMPLOYER’S FEIN:____________________________
T.J. Maxx
250 Pooler Parkway; The Village on Pooler Parkway, Pooler, GA, 31322 EMPLOYER’S WH#:____________________________
Do not accept forms claiming additional allowances unless the worksheet has been completed. Do not accept forms
claiming exempt if numbers are written on Lines 3 - 7.
G-4 (Rev. 02/15/19)
INSTRUCTIONS FOR COMPLETING FORM G-4

Enter your full name, address and social security number in boxes 1a through 2b.
Line 3: Write the number of allowances you are claiming in the brackets beside your marital status.
A. Single – enter 1 if you are claiming yourself
B. Married Filing Joint, both spouses working – enter 1 if you claim yourself
C. Married Filing Joint, one spouse working – enter 1 if you claim yourself or 2 if you claim yourself and your spouse
D. Married Filing Separate – enter 1 if you claim yourself
E. Head of Household – enter 1 if you claim yourself
Line 4: Enter the number of dependent allowances you are entitled to claim.
Line 5: Complete the worksheet on Form G-4 if you claim additional allowances. Enter the number on Line H here.
Failure to complete and submit the worksheet will result in automatic denial on your claim.
Line 6: Enter a specific dollar amount that you authorize your employer to withhold in addition to the tax withheld based on your
marital status and number of allowances.
Line 7: Enter the letter of your marital status from Line 3. Enter total of the numbers on Lines 3-5.
Line 8:
a) Check the first box if you qualify to claim exempt from withholding. You can claim exempt if you filed a Georgia income tax
return last year and the amount of Line 4 of Form 500EZ or Line 16 of Form 500 was zero, and you expect to file a Georgia
tax return this year and will not have a tax liability. You cannot claim exempt if you did not file a Georgia income tax return
for the previous tax year. Receiving a refund in the previous tax year does not qualify you to claim exempt.
EXAMPLES: Your employer withheld $500 of Georgia income tax from your wages. The amount on Line 4 of Form 500EZ
(or Line 16 of Form 500) was $100. Your tax liability is the amount on Line 4 (or Line 16); therefore, you do not qualify to
claim exempt.
Your employer withheld $500 of Georgia income tax from your wages. The amount on Line 4 of Form 500EZ (or Line 16 of
Form 500) was $0 (zero). Your tax liability is the amount on Line 4 (or Line 16) and you filed a prior year income tax return;
therefore you qualify to claim exempt.
b) Check the second box if you are not subject to Georgia withholding and meet the conditions set forth under the
Servicemembers Civil Relief Act. Under the Act, a spouse of a servicemember may be exempt from Georgia income tax on
income from services performed in Georgia if:
1. The servicemember is present in Georgia in compliance with military orders;
2. The spouse is in Georgia solely to be with the servicemember;
3. The servicemember maintains domicile in another state; and
4. The domicile of the spouse is the same as the domicile of the servicemember or the spouse of the servicemember has
elected to use the same residence for purposes of taxation as the servicemember.
Additional information for employers regarding the Military Spouses Residency Relief Act:
1. On the W-2 the employer should not report any of the wages as Georgia wages.
2. If the spouse of a servicemember is entitled to the protection of the Military Spouses Residency Relief Act in another
state and files a withholding exemption form in such other state, the spouse is required to submit a Georgia Form G-4
so that withholding will occur as is required by Georgia Law when a Georgia domiciliary works in another state and
withholding is not required by such other state. If the spouse does not fill out the form, the employer shall withhold
Georgia income tax as if the spouse is single with zero allowances.
Worksheet for calculating additional allowances. Enter the information as requested by each line. For Line 2D, enter items such
as Retirement Income Exclusion, U.S. Obligations, and other allowable deductions per Georgia Law, see the IT-511 booklet for
more information.
Do not complete Lines 3-7 if claiming exempt.
O.C.G.A. § 48-7-102 requires you to complete and submit Form G-4 to your employer in order to have tax withheld from your
wages. By correctly completing this form, you can adjust the amount of tax withheld to meet your tax liability. Failure to submit a
properly completed Form G-4 will result in your employer withholding tax as though you are single with zero allowances.
Employers are required to mail any Form G-4 claiming more than 14 allowances or exempt from withholding to the Georgia
Department of Revenue for approval. Employers will honor the properly completed form as submitted pending notification from
the Withholding Tax Unit. Upon approval, such forms remain in effect until changed or until February 15 of the following year.
Employers who know that a G-4 is erroneous should not honor the form and should withhold as if the employee is single claiming
zero allowances until a corrected form has been received.
Employment Eligibility Verification USCIS

Department of Homeland Security Form I-9
OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 10/31/2022
►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an
employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the
documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any)
Robinson Kisha L Smith
Address (Street Number and Name) Apt. Number City or Town State ZIP Code
102 Riddick Lane N/A Savannah GA 31407

Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's E-mail Address Employee's Telephone Number
10/09/1981 2 2 4 - 2 5 - 4 4 2 8 N/A N/A
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in
connection with the completion of this form.
I attest, under penalty of perjury, that I am (check one of the following boxes):
✔ 1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)
3. A lawful permanent resident (Alien Registration Number/USCIS Number):
4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):

Some aliens may write "N/A" in the expiration date field. (See instructions)
QR Code - Section 1
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: Do Not Write In This Space
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1. Alien Registration Number/USCIS Number:

OR
2. Form I-94 Admission Number:
OR
3. Foreign Passport Number:
Country of Issuance:
Signature of Employee Today's Date (mm/dd/yyyy) 24-May-2021 | 8:59 AM ED
Preparer and/or Translator Certification (check one):

✔ I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator Today's Date (mm/dd/yyyy)
Last Name (Family Name) First Name (Given Name)
Address (Street Number and Name) City or Town State ZIP Code
Employer Completes Next Page
Form I-9 10/21/2019 Page 1 of 3

Form I-9 Supplement, USCIS

Section 1 Preparer and/or Translator Certification Form I-9
Supplement
Department of Homeland Security OMB No. 1615-0047
U.S. Citizenship and Immigration Services Expires 10/31/2022
Last Name (Family Name) First Name (Given Name) Middle Initial
Employee Name:
Robinson Kisha L
Instructions: This supplement may be used if extra spaces are required to document more than one preparer and/or translator
assisting an employee in completing Section 1 of Form I-9. The preparer and/or translator must enter the employee's name in
the spaces provided. Each preparer or translator must complete, sign and date a separate certification area. Employers must
retain completed supplement sheets with the employee's completed Form I-9.
Signature of Preparer or Translator Date (mm/dd/yyyy)
Form I-9 Supplement 10/21/2019 Page 1 of 1

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DocuSign Envelope ID: 91BF1F46-E7B0-4FA2-9A3B-F8742FD7FD1B

Go Paperless for Earnings Statements

Kisha Laynette Robinson

24-May-2021 | 8:59 AM EDT

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

New Health Insurance Marketplace Coverage Form Approved

PART A: General Information

What is the Health Insurance Marketplace?

Can I Save Money on my Health Insurance Premiums in the Marketplace?

How Can I Get More Information?

PART B: Information About Health Coverage Offered by Your Employer

3. Employer name 4. Employer Identification Number (EIN)

The TJX Companies, Inc. 042207613

 With respect to dependents:

We do not offer coverage.

ACKNOWLEDGMENT AND AUTHORIZATION

Applicant’s Signature Date

Background Information – All Applicants

Other Names/Alias _____________________________________________________________________________

Complete This Section after Applicant Accepts Conditional Offer of Employment

Revised 04/18 Page 1 of 1

FIELD ASSOCIATE NON-MANAGEMENT ORIENTATION CHECKLIST

VIOLATIONS THAT MAY LEAD TO IMMEDIATE TERMINATION

13. IMPROPER JOB PROCEDURES - Failure to follow established job procedures.

Rev 02/19 Page 1 of 2

FIELD ASSOCIATE NON-MANAGEMENT ORIENTATION CHECKLIST

OTHER VIOLATIONS THAT MAY LEAD TO CORRECTIVE ACTION

6. INAPPROPRIATE CLOTHING/FOOTWEAR - Not following the Company’s Dress Code Policy.

Rev 02/19 Page 2 of 2

Form W-4 Employee’s Withholding Certificate OMB No. 1545-0074

Employers Employer’s name and address First date of Employer identification

Form W-4 (2021) Page 2

General Instructions Specific Instructions

Form W-4 (2021) Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

Step 4(b)—Deductions Worksheet (Keep for your records.)

Form W-4 (2021) Page 4

TJX Associate Assistance Program

To Access TAAP (available 24 hours a day)

The TJX Associate Assistance Program (TAAP)

When is Eligibility Effective?

When Does Eligibility End?

TAAP provides assistance and guidance on issues that matter to you:

The TJX Associate Assistance Program (TAAP)

How to Contact TAAP

Visit the TAAP website www.taaptjx.com (Username: TJX | Password: TAAP)

To talk with a TAAP counselor, call 866-589-2347.

TTY Services: 866-228-2809

Complaint Process & Claims Procedure

Crisis Management Group Associates, Inc.

What is COBRA continuation coverage?

The TJX Associate Assistance Program (TAAP)

When is COBRA continuation coverage available?

How is COBRA continuation coverage provided?

If you have questions

Keep the Plan informed of address changes

Notice of Privacy Practices

Notice of Privacy Practices

Effective date: September 23, 2013