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SAG-AFTRA WMA PR Form

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Performer Name*

Phone*

Last Four Digits - Social Security Number

Email*

Hours Worked

Agent

CATEGORY

Announcer/Narrator/Off-Camera

On-Camera Performer

Background

Hand Model

Singer

On-Camera Narrator

Day Player

Half-Day Player

Was Wardrobe provided by the performer, if so how many?

Commercials (23.5%)

Audio (AFTRA Retirement)

TV (SAG Pension

Regional Commercial (19.95%)

Audio (AFTRA Retirement)

TV (SAG Pension_

13 Weeks

1 Year

*Under WMA CoEd Waiver, Category II rates to be negotiated at the time of engagement

Programs (AFTRA Retirement)

Cable Program (21.3%)

Television Program (21.0%)

Public Television Program (17.1%)

Radio Program (11.5%)

Public Run Program (11.5%)

Other

Audio Books ____% (AFTRA)

New Media ____% (SAG)

Electronic Media ____% (AFTRA)

Interactive Media 17% (AFTRA)

Fill in precentage rate for Audio Books/New Media/Electronic Media:

Date of Session

Month

Day

Year

Production Company

Location/Studio (State)

Producer

Sponsor

Signatory

Length of Production

Fee to be Paid by

Title

Market/Units

Date(s) of Broadcast

Station

Network

Synd

Compensation (Session)

Compensation (Residuals/Use)

Total Gross Compensation

SAG-AFTRA Health Plan Contribution

Pay Period Ending

Make payable to “SAG-AFTRA Health Plan.” Send the check and a copy of this document to: SAG-AFTRA Health Plan, P.O. Box 54867, Los Angeles, CA 90054

Additional Information

Click "Submit" to send your SAG-AFTRA Washington-Mid Atlantic Production Report to Production Payroll Services. We will contact you if necessary.

Call

123-456-7890

info@mysite.com

Production Payroll Services

301-371-5910

admin@ProductionPayrollServices.com

5257 Buckeystown Pike #250
Frederick MD 21704

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