Page 4 - GFSI-Cover Module 2
P. 4

Payroll Copy


                                                                                     Form No: HRF-BEN-001
                                             Authority to Deduct                     Version No: 00-10.01.11

                                                                                     For Internal Use Only

         ID #                                                  Position:
         Name:                                                 Date Prepared:
         Date Hired:                                           Effectivity Date:


        This is to authorize Payroll/the Company to make the following salary deduction from my payroll:

                       Category                                            Details
          Purpose for Deduction
          Department
          Total Amount
          Amount to be deducted per payroll
          Start Date of Deduction
          Last Date of Deduction



        Approved by:                                                     Conforme:



                                                                  Signature over Printed Name
           Signature over Printed Name




                                                                                                        Payroll Copy

                                                                                     Form No: HRF-BEN-001

                                             Authority to Deduct                     Version No: 00-10.01.11

                                                                                     For Internal Use Only

         ID #                                                  Position:
         Name:                                                 Date Prepared:
         Date Hired:                                           Effectivity Date:


        This is to authorize Payroll/the Company to make the following salary deduction from my payroll:
                       Category                                            Details
          Purpose for Deduction
          Department
          Total Amount
          Amount to be deducted per payroll
          Start Date of Deduction
          Last Date of Deduction



        Approved by:                                              Conforme:




                                                                    Signature over Printed Name
           Signature over Printed Name





        HRF-BEN-001
        01-05.18.12
        Restricted
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