INTERACTIVE MULTI-PURPOSE COOPERATIVE

AUTHORITY TO DEDUCT

I, , hereby authorize Interactive Multi-Purpose

Cooperative to deduct from my salary the amount of
____________________________________Only (₱_______) this cut off
________________ for the payment of my Fit to Work Medical Examination as part of
my Pre-employment requirements

___________________________ ____________________________
Date Member-worker’s Signature

INTERACTIVE MULTI-PURPOSE COOPERATIVE

AUTHORITY TO DEDUCT

I, , hereby authorize Interactive Multi-Purpose

Cooperative to deduct from my salary the amount of
____________________________________Only (₱_______) this cut off
________________ for the payment of my Fit to Work Medical Examination as part of
my Pre-employment requirements

___________________________ ____________________________
Date Member-worker’s Signature