Deduction at source form

"*" indicates required fields

Personal address*

Salary deduction

I authorize the CIUSSS du Centre-Sud-de-l' Île-de-Montréal Payroll Department to deduct from each of my paychecks the amount of:*


Enter your name
MM slash DD slash YYYY

u003culu003ern tu003cliu003eDownload, print out, and complete the u003ca href=u0022 tu003cliu003eSend via internal mail to the Foundation: code 34u003c/liu003ernu003c/ulu003e

To stop or change a payroll deduction, contact your payroll department.