Print This Form |
PART-WITHDRAWAL FORM |
|
||||
SURNAME…………………………………… | OTHER NAMES………………………………........................ | ||||
ORACLE NO……………………..…………... | MEMBERSHIP NO …………………………......................... | ||||
MDA ADDRESS ………………….……..………............................................................................................................ | |||||
OFFICE/SCHOOL …………………………………………………………………………..……………….................... | |||||
AMOUNT APPLIED ……………………………………………………………………………………..……………………... | |||||
TOTAL DEDUCTION ..……………………………………………………………………………………………..…………… | |||||
NET PAY (attachment of recent payslip) ………….………………………………………………………… (compulsory) | |||||
E-Mail ADDRESS ………………………………………………………………………..…………………Tel No .……………….......... | |||||
NEXT OF KIN ………………………………………………………………………………Relationship ………..................................... | |||||
ADDRESS ……………………………………………………………………………….. PHONE No ……………………………......... | |||||
I ………………………………………………………………..hereby authorize the above named society to deduct my outstanding debt from my salary for 18 months (maximum repayment period), with effect from the month of …………………… to ……………
………………………………………………………………. |
|||||
CAVEAT EMPTOR ……………………………………………………… …………………………………………………………… |
|||||