Authority To Deduct Form Insurance
Authority To Deduct Form Insurance
Authority To Deduct Form Insurance
TO : ACCOUNTING DEPARTMENT
FROM : HR DEPARTMENT
AREA/DEPT : _________________________
DATE : _________________________
RE : Authority to Deduct (ATDF2)
Authority to Deduct
This is to authorize my employer, Ace Promotion and Marketing Corporation (APMC), its Treasurer or its Finance,
Accounting and/or Payroll Officer, to deduct from my payroll the amount of ___________________________in 1 time
deduction to serve as payment to one (1) year Life Insurance coverage under SPECTACROM
I further understand that this Insurance Coverage will be beneficial to me and my family.
AGE _______________
_____________________________
Name and Signature
TO : ACCOUNTING DEPARTMENT
FROM : HR DEPARTMENT
AREA/DEPT : _________________________
DATE : _________________________
RE : Authority to Deduct (ATDF2)
Authority to Deduct
This is to authorize my employer, Ace Promotion and Marketing Corporation (APMC), its Treasurer or its Finance,
Accounting and/or Payroll Officer, to deduct from my payroll the amount of ___________________________in 1 time
deduction to serve as payment to one (1) year Life Insurance coverage under SPECTACROM.
AGE _______________
_____________________________
Name and Signature