SSCG AMENDMENT TO PAY

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1. Amendment To Pay
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Fill this form out when too much or too little pay has been made or when a payment has to be made that isn't listed on the system,. Any information on this form must be backed up with evidence of under or over payments. This Form can only be used for one individual per form.

1. Please complete all of these personal details *

Name of Employee	*
Payroll Number	*
Name of person Completing the form	*
Pay period Affected	*

2. Changes that need to be made

	Add/Deduct	Date of Change	Shift Affected Place of assignment	Hours diff	Miles Diff	Total Value
1	1 Add/Deduct	1 Date of Change	1 Shift Affected Place of assignment	1 Hours diff	1 Miles Diff	1 Total Value
2	2 Add/Deduct	2 Date of Change	2 Shift Affected Place of assignment	2 Hours diff	2 Miles Diff	2 Total Value
3	3 Add/Deduct	3 Date of Change	3 Shift Affected Place of assignment	3 Hours diff	3 Miles Diff	3 Total Value
4	4 Add/Deduct	4 Date of Change	4 Shift Affected Place of assignment	4 Hours diff	4 Miles Diff	4 Total Value
5	5 Add/Deduct	5 Date of Change	5 Shift Affected Place of assignment	5 Hours diff	5 Miles Diff	5 Total Value
6	6 Add/Deduct	6 Date of Change	6 Shift Affected Place of assignment	6 Hours diff	6 Miles Diff	6 Total Value
7	7 Add/Deduct	7 Date of Change	7 Shift Affected Place of assignment	7 Hours diff	7 Miles Diff	7 Total Value

3. Declaration
if you give false information in order to affect an employee'e wage, you may have to pay a financial penalty to cover the costs to the company and or face disciplinary action up to and including dismissal *

	DD/MM/YYYY

4. i declare that to the best of my knowledge and belief that the information i have given on this form is correct and complete. *

Name	*
Date	*