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_____________ and presently holding the position of ___________________________. He/she is receiving the following compensation: A. Gross Monthly Salary Basic Allowances Others (pls. specify) P ________________ ________________ ________________ Total Monthly Salary P ________________ B. Monthly Deductions (as of __________) Withholding Tax GSIS/SSS Contributions Pag-IBIG Contributions Philhealth Contributions Loans (pls. specify) P ________________ ________________ ________________ _______.

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