AUTHORITY TO DEDUCT

(Cash Advances)

I, _____________________________________________, hereby authorized my

employer, ______________________________________, to deduct from my salary, on a bi-

monthly basis, the amount of ____________________________. I understand that this

deduction will reduce my total gross salary.

This deduction is in relation to a cash advance I made from my employer dated

___________________________, in the amount of __________________________.

I have fully understood and agreed that this Authority to Deduct is VALID AND

BINDING until the full satisfaction of this cash advance.

By:

__________________________________
EMPLOYEE

Assisted By:

___________________________________
UNION OFFICER