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EMPLOYEE LOAN FORMAT

Loan value: _________________________________$ (____________)

Worker's full name and surname: _________________________

Proof of receipt and authorization

I received from the company _____________________________________ the

aforementioned amount, as a loan or interest-free loan on my salaries.

I hereby expressly authorize the company's paymaster to deduct from my wages

as follows:

a) Fees in the amount of $______________, which will be deducted from each

payment _________________.

b) The service bonus for June and December shall be discounted equal to the
amount of the quota established in the previous point.

I also expressly authorize the employer to withhold and collect from my final
settlement of social benefits, salaries and indemnities, the balances owed, if my
employment contract is terminated before the full payment of this loan is
completed.

I received in compliance:

__________________
C.C.

Approved by ____________ Payroll clerk ___________

Loan delivery through _______________________