Staff Repayment Form

Driver …………………………………………………………

Date …………………………………………………………

Item …………………………………………………………

PO Number …………………………………………………………

Place of Purchase …………………………………………………………

Amount to be repaid by Igloo Employee (max over 6 months)………..……………………………

1st Payment amount …………………………………………………………

2nd Payment amount …………………………………………………………

3rd Payment amount …………………………………………………………

4th Payment amount …………………………………………………………

5th Payment amount …………………………………………………………

6th Payment amount …………………………………………………………

1st Payment will be taken out of your wage on …………………………………………………………

Subsequent payments will be taken out in the following months.

I have read and understood the above

Name Printed …………………………………………………………

Signature …………………………………………………………

Date …………………………………………………………

Please make a copy of this form and give one to the employee the other to be scanned and emailed
to J. Patel and S Holmes

21-Mar-23
668977396.docx