Stoppage Form

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Date: _________________

The Chief
Regional Payroll Services Unit
Budget and Finance Division
DepEd-NCR

Dear Sir:

I hereby authorize your good office to please STOP/DEDUCT the following


effective as indicated hereunder:

STOP
EFFECTIVITY TERMINATION
CODE DESCRIPTION POLICY NO. AMOUNT
DATE DATE

DEDUCT
EFFECTIVITY TERMINATION
CODE DESCRIPTION POLICY NO. AMOUNT
DATE DATE

Attached herewith is my payslip/supporting document(s)


Hoping for your favorable action.

Very truly yours,

PRINTED NAME WITH SIGNATURE:


DIVISION/STATION CODE:
EMPLOYEE NO.:

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