Zapof

Salary Sacrifice Application Form - Child Care

 

Employee Information

 

First Name

Last Name

Employee ID

Job Title

Department

Date

Children Information

 

No. of children

Days per week

Child's Name

Child's Name

Child's Name

Child's Name

Child Care Provider Information

 

Company Name

 

Address

 

Contact Number

 

Salary Sacrifice Details

 

Amount to be salary sacrificed

Effective Date

Frequency of Payment

Weekly

Fortnightly

Monthly

 

Authorizations

 
  • I hereby authorize my employer to deduct the specified amount from my pre-tax salary for the purpose of paying my child care fees to the designated provider.
  • I understand that the amount salary sacrificed will not be subject to income tax.
  • I acknowledge that I may be eligible for government subsidies for child care expenses.
  • I understand that this authorization may be revoked in writing at any time.
 

Employee Signature

Manager/HR Representative Signature

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