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PAYROLL DEDUCTION AUTHORIZATION FORM

Today’s Date : __________________________


Effectivity Date : __________________________
Employee Name : __________________________

TYPE OF DEDUCTION AMOUNT DEDUCTION PER CUT-OFF

I hereby authorize MCWMC to make the above deduction/s from my pay in accordance with the above terms. I understand
and agree that I am responsible for satisfying the above amount/s. I understand and agree that any amount due and owing at
the time of my termination, regardless whether my termination was voluntary or not, will be deducted on my last paycheck
or any amounts that may be owed to me.

__________________________________
Signature Over Printed Name / Date

PAYROLL DEDUCTION AUTHORIZATION FORM

Today’s Date : __________________________


Effectivity Date : __________________________
Employee Name : __________________________

TYPE OF DEDUCTION AMOUNT DEDUCTION PER CUT-OFF

I hereby authorize MCWMC to make the above deduction/s from my pay in accordance with the above terms. I understand
and agree that I am responsible for satisfying the above amount/s. I understand and agree that any amount due and owing
at the time of my termination, regardless whether my termination was voluntary or not, will be deducted on my last
paycheck or any amounts that may be owed to me.

__________________________________
Signature Over Printed Name / Date

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