HTML Preview Salary Deduction Complaint Letter page number 1.
FINANCIAL POLICY AND PROCEDURE PAPER #29FINANCIAL POLICY AND PROCEDURE PAPER #29
SALARY ADVANCE REQUESTSALARY ADVANCE REQUEST
AND PAYROLL DEDUCTION FORMAND PAYROLL DEDUCTION FORM
University of WisconsinUniversity of Wisconsin--
Employe's Name PrintedEmploye's Name Printed Employe's Social Security NumberEmploye's Social Security Number
I request a salary advance of $_______________ and authorize a payroll deduction of an equal amount toI request a salary advance of $_______________ and authorize a payroll deduction of an equal amount to
be taken from my first paycheck of this pay period. If sufficient salary, net of all mandatory deductions,be taken from my first paycheck of this pay period. If sufficient salary, net of all mandatory deductions,
is not available to repay the advance on the first check of this pay period, the maximum amount possibleis not available to repay the advance on the first check of this pay period, the maximum amount possible
will be deducted for repayment and will continue to be deducted from subsequent paychecks until thewill be deducted for repayment and will continue to be deducted from subsequent paychecks until the
salary advance is repaid. In the event that I should terminate employment with the University prior tosalary advance is repaid. In the event that I should terminate employment with the University prior to
repayment of the entire advance, I fully understand that any unpaid balance will then becomerepayment of the entire advance, I fully understand that any unpaid balance will then become
immediately due and payable to the University.immediately due and payable to the University.
Employe's SignatureEmploye's Signature Date SignedDate Signed
Employe's Departmental Accounting CodeEmploye's Departmental Accounting Code Printed Name of Person Authorizing SalaryPrinted Name of Person Authorizing Salary
AdvanceAdvance
Signature of Person Authorizing Salary AdvanceSignature of Person Authorizing Salary Advance Date SignedDate Signed
This form is to be prepared by the Institution Payroll or Personnel Office and signed by the employe andThis form is to be prepared by the Institution Payroll or Personnel Office and signed by the employe and
person authorizing the advance.person authorizing the advance.
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