ID Number:________________________
Personal Address:__________________
_______________
_______________
Contact Number:___________________
E-Mail:___________________________
Company Name:___________________
Employee Number:_________________
Company Address:__________________
_______________
_______________
Employee:
I , ________________________ the abovementioned employee hereby request that my payroll or finance department deduct
R_______ in accordance with the agreement I have with PayDayInc Loans on or before my pay/salary transfer date being the
___ of _________, 20___.
_________________[Signature] ____________[Date]_________________[Place]
Payroll Admin:
I , ________________________ the abovementioned duly authorized person hereby promises to pay R_______ in accordance
with the agreement the employee has with PayDayInc Loans on or before his/her pay/salary transfer date being the ___ of
_________, 20___.
_________________[Signature] ____________[Date]_________________[Place]
2. Confirm that all information contained herein is true, accurate and current. Any misleading action or false information will be
constituted as fraud and prosecuted accordingly.