NAME OF EMPLOYER: EMPLOYER HESLB CODE NO :POSTAL ADDRESS :

TELEPHONE:E-MAIL: PAYROLL MONTH :

S/NO INDEX NUMBER PF/CHECK NO. NAME OF LOANEE AMOUNT DEDUCTED OUTSTANDING BALANCE

TOTAL DEDUCTIONS

Paid by cheque No:…………………………………………Dated:…………………………………………………Paid in by:………………………

HESLB Receipt No. Issued:…………………………………Date of Receipt:…………………………………… Receipted By:……………………

HESLB LOAN MONTHLY REPAYMENT SCHEDULE(To be submitted duly completed with every payment to HESLB)

PAYMENT DETAILS