Payroll Advance request form

Employee Name:
Department:
Position:
Direct Manager's Name :
Employment date:

I request a salary advance of $_______________ for the following reason: (2 salaries max)

Family or personal emergencies

Please specify:

Supportive documents that I will provide:

Medical or Hospital bills not covered by the Social Security fund or medical insurance for self or
a dependent, such cases should be supported by a medical report.

Please specify:

Supportive documents that I will provide:

Foreigner travel loan.

Please specify:

Supportive documents that I will provide:

If my request is approved, I authorize a monthly payroll deduction of ____LBP equal amounts of

____LBP to be taken from my monthly paycheck over a period of ____ months starting from ____
ending ____.

I acknowledge that by signing this form, in the event that my employment will be terminated with
M.Ezzat Jallad & Fils prior to repayment of the entire advance, I fully understand that any unpaid
balance will then become immediately due and will be totally deducted from my final paycheck.

Employee Signature HOD Signature Finance Manager HR Manager

Date Date