Authority To Deduct Form Insurance

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ACE PROMOTION AND MARKETING CORPORATION

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.

Employee’s Birthdate Position Beneficiary Relationship


/ /

AGE _______________
_____________________________
Name and Signature

ACE PROMOTION AND MARKETING CORPORATION

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.

Employee’s Birthdate Position Beneficiary Relationship


/ /

AGE _______________

_____________________________
Name and Signature

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