Donation Confirmation Form

Name *

First Name Last Name
Id Number *
Employee Number (On Payslip) *
I hereby authorise IoT.nxt to make the following deductions from my monthly salary (please select appropriate amount and time period in box below), so that IoT.nxt can make a donation to the charity mentioned below:
Amount *
Custom Amount
Period *
Start on Payroll Month *

Month Day Year
Date
Charity *
Date of Signature

Month Day Year
Date
Signature *

Clear
Should be Empty: