Name Surname:
SSI No:
Department/Duty:
Personnel No:
Event subject to wage deduction penalty:
Occurrence: ………………
Based on:
Date:
Daily Amount:
Deduction Amount:
Date/Signature
Name Surname:
SSI No:
Department/Duty:
Personnel No:
Event subject to wage deduction penalty:
Occurrence: ………………
Based on:
Date:
Daily Amount:
Deduction Amount:
Date/Signature