STAFF SALARY ADVANCE FORM

Applicant’s Name; ……………….

Telephone; ………………………….
Email Address; ………………………
Account Number; …………………..
I am kindly requesting the finance department to provide for me a salary advance
to help me cater for some emergency concerns as I have explained to the finance
department amounting to Ugx……………………………
I commit myself to pay the above requested amount in one equal installment to be
deducted off my salary of the month of ………………. 20…
I shall be grateful if my humble request is considered.
Thank you.
Applicant’s signature……………………………………

For official use only

Form received by…………………………………………………………..
Date……………………………………….
(Name Signature)

Finance Officer………………………………………………………………
Date…………………………………………
(Name and Signature)

Approved
by………………………………………………………………….Date…………………………………………
(Name and Signature)