PSU FORM 101 Revised

Date:

NOTICE OF NEW DEDUCTION

Division Name / Number:

Station Name:
(School for Secondary / District for Elementary)

Station Number:

Employee Number:

Employee Name:

Employee Signature:

DEDUCTION DATE OF DATE OF

DEDUCTION NAME CODE
AMOUNT EFFECTIVITY TERMINDATION

List of Government Deduction

DEDUCTION NAME DEDCODE DEDUCTION NAME DEDCODE
ADD'L GSIS PREMIUM 011 GSIS PABAHAY HOUSING PROG. 131
ADD'L PAG-IBIG PREMIUM 912 GSIS POLICY LOAN 001
GSIS ELA 099 GSIS PRUDENTIAL LIFE 006
GSIS C.E.A. PLAN 186 GSIS REAL ESTATE LOAN 031
GSIS EDU. LOAN 129 GSIS S O S 021
GSIS EDUCHILD 015 GSIS ENHANCED SALARY LOAN 002E
GSIS EMERGENCY LOAN 704 GSIS SALARY LOAN 002
GSIS GENESIS FLEXI 019 GSIS UNLIMITED OPT 090
GSIS HOSPT INS. PLAN 187 NHMFC 998
GSIS HOSPITALIZATION 016 PAG-IBIG EMER. LOAN 334
GSIS LIFE & RETIREMENT 003 PAG-IBIG HOUS. LA 332
GSIS L-PREM. ARREARS 018 PAG-IBIG KASIPAGAN LOAN 333
GSIS MEM CASH / SERVICE 022 PAG-IBIG LOT PURCHASE 331
GSIS MEM / GEN. 014 PAG-IBIG MULTI-PURPOSE LOAN 336
GSIS CAL (ECARD) 026 PAG-IBIG PREMIUM 222
GSIS OPT. INS, PREMIUM 013 PAG-IBIG PROV. LOAN 335
GSIS OPT POLICY LOAN 108 DECS PROVIDENT LOAN 110
GSIS CONSOLIDATED LOAN (CONSO) 132 GSIS ECARD PLUS (CASH ADVANCE) 133

(STAMP RECEIVED BY COMPANY CONCERNED)

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