Name: Date

Current Position: Current Employer:

ITEM AMT MOS REMARKS

Monthly Base Pay
Is the entire amount taxable? Tax rate?
Profit Sharing
Amount, Description of Program Used
Annual Salary Increase
Amount, Description of Program Used
Guaranteed Bonuses
Amount of Guaranteed Bonuses, Description of Program
Used, Frequency of pay-out in a year
Variable Bonuses
Amount, Description of Program Used (Economic
Assistance, etc.)
Incentive Bonuses (Government Exams)
Amount, Program Used
Communication Allowance
Amount of allowance for official business calls; unit
provided or paid out through monthly reimbursement
Rice Allowance
Amount or # of sacks
Meal Allowance
Amount

Transportation Allowance
Amount

Uniform Allowance
Amount
Car Plan
Value, # of years, Interest Rate, Coverage, Vehicle
entitlement - type/model
Parking
Amount, if applicable
Health Benefits
Coverage of HMO for employee (medicines, room,
procedures, etc.) and for dependent (room and
consultation only); HMO Service Provider
Group Life Insurance
Amount
Housing Loan
Amount, # of Years, Interest Rate, Loan Provider
Salary Loan
Amount, # of Years, Interest Rate, Loan Provider
Education Subsidy
Amount, Description of the Program
Provident Fund
Retirement Benefits
Club Membership or Playing rights
Stock Options
Description of the Program
Sick Leave Credits
Number of Credits, Accumulated or Commutable to Cash
Vacation Leave Credits
Number of Credits, Accumulated or Commutable to Cash
Emergency Leave Credits
Name: Date
Current Position: Current Employer: