CREDIT ACCOMMODATION REQUEST FORM

3 months 6 months 1 year

Name of Employee: ________________________________ Technician

Aubrey Ubay Position: _________________
Department: ______________________________________ Date Filed: January 29 2024
_______________

Form of Credit Accommodation Amount

* Salary Loan 2000

P ___________________________
Educational Loan P ___________________________
Emergency Loan P ___________________________

Loan Purpose:
Motorcycle registration
________________________________________________________________________________
________________________________________________________________________________

Recommended by: __________________________

(Department Head / Date)

(To be accomplished by Payroll Analyst)

Present Loan Obligations:

Type Outstanding Balance Monthly Deduction

________________ _________________________ ______________________
________________ _________________________ ______________________
________________ _________________________ ______________________

Total Monthly Deductions P ________________________

Total Monthly Deductions (including new CA) P ________________________

Total Gross Pay Less all Deductions P ________________________

Prepared by: Noted by:

_________________________ _________________________
Payroll Analyst Human Resource Supervisor

Approved
Disapproved
____________________________
Avon G. Saliganan
Human Resource Manager
 AUTHORITY TO DEDUCT FROM SALARY / PROMISSORY NOTICE

I, the undersigned, hereby acknowledge that I am indebted to AMICI MERCANTILE INC., AMICI WATER
SYSTEMS SALES AND SERVICES, THERMOVAR PIPES SALES AND SERVICES, NOUVAC TECHNOLOGIES AND
SEVICES, TRANSFLOW PUMP TECNOLOGIES INC., WAVOLUTION TECHNOLOGIES INC. and BASED ON
SCIENTIA INC. in the amount of
Two thousand pesos
_________________________________________________________________
2000
(P ___________________.

For the value received, I authorized the company to deduct from my semi-monthly salaries and
commissions (for sales employees) the amount of ____________________________ (P ________________),
corresponding to the said semi-monthly installments until the said indebtedness is fully paid.

It is hereby agreed that if default be made in the payment of my monthly installments, as when the
same becomes due and payable, the total principle sum of the remaining unpaid, shall at once become due
and payable.

Furthermore, in case of my separation from the company for any cause of whatsoever, any unpaid
balance from my loans/shall come due and demandable and I promise to fully settle the same immediately.

______________________________
Printed Name/ Signature

______________________________
Date