Stoppage-Deduction Form

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Date: The Chief Regional Payroll Services Unit Budget and Finance Division Dep Ed NCR Dear Sir:

I hereby authorized your good office to please STOP / DEDUCT the following effective as indicated hereunder: S T O P
CODE DESCRIPTION POLICY NO.
EFFECTIVITY DATE TERMINATION DATE

AMOUNT

DEDUCT
CODE DESCRIPTION POLICY NO.
EFFECTIVITY DATE TERMINATION DATE

AMOUNT

Attached herewith is my payslip/supporting document (s). Hoping for your favorable action.

Very Truly Yours, PRINTED NAME WITH SIGNATURE: DIVISION/STATION: EMPLOYEE NO.:

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