Deduction Form

Full Name:

Today's Date:

Station:

Total Requested Amount: £

Reason for Deduction:

Payment Plan: £ per

Effective Date:

Effective Week:

I hereby authorise Kedan Transport Ltd to make the above deduction from my pay in accordance
with the above terms. I understand and agree I am responsible for the satisfying the above
amounts. I understand and agree that any amount that is due and outstanding at the time of my
termination, regardless of whether my termination was voluntary or not, will be deducted from
my last invoice or any other amounts that may be owed to me. This authorises Kedan Transport to
retain the entire amount of my last invoice in compliance with the law.

Name:

Signature:

Date: