Faire un don par déduction à la source

Formulaire de déduction à la source

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Prénom Nom

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Direction*

Adresse personnelle*

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Téléphone*

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Prélèvement sur le salaire

Par la présente, j’autorise le Service de la paie du CIUSSS du Centre-Sud-de-l’ Île-de-Montréal à prélever sur chacune de mes paies la somme de :*

Signature

Signature*

Inscrire votre nom

Date du jour*

Acceptation*

En cochant cette case, j'accepte que le service de la paie du CIUSSS du Centre-Sud-de-l'Ïle-de-Montréal prélève le montant inscrit dans la section "prélèvement sur le salaire" à chaque paie.

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