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Employee Name
Taxation Identification No:
Location
Department
Current
Proposed
Title
Salary Grade
Base Rate
Merit Amount
Promotion Amount
Other Amount
Bonus
Effective Date
Type of Proposed Increase:
[ ] New Hire [ ] Merit [ ] Promotion [ ] Other
Date of Last Increase
Type of Last Increase:
Explanation for Proposed Salary Increase
Approvals:
Supervisor ____________________ Date
Manager _______________________ Date
Div. Man. Dire.________________ Date
Personnel Dept. ________________ Date