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Salary Advance Requisition Form

DATE:

EMP. NAME EMP. CODE.

DESIGNATION GRADE

DEPARTMENT LOCATION

Kindly sanction me an advance of Rs. (In words

for the purpose of

that can be recovered in month(s) @ Rs. per month.

Employee Signature HOD Signature

FOR THE USE OF HR DEPARTMENT


Years No. of Total Net Pay
Outstanding Present
B a s i c Salary Served in Times (Per month)
Amt. Availed Advance as on Deduction
(Per month) as on
per month

Rs. S & Co. Availed Rs. Months Rs.


Rs. Rs.

Payroll Incharge Verified by

SANCTIONING AUTHORITY RECOMMENDATION

FOR THE USE OF ACCOUNTS DEPT.

Salary advance of Rs. (In words

has paid on can be deducted @ Rs. (In words

per month w.e.f. for months.

Accounts Department
* As per the policy maximum Monthly Installments can be extended to 12 months only.

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