Finance Payroll Allocation Form 

Employee Name	[Your Name]
Employee ID	[EMP12345]
Department	[Production]
Position	[Senior Engineer]
Payroll Period	[January 2051]

Earnings Allocation

Earnings Component	Amount ($)
Regular Salary	[$5,000]
Overtime Pay
Bonuses
Commissions
Other Earnings
Total Earnings

Deductions Allocation

Deduction Component	Amount ($)
Federal Tax	[$1,200]
State Tax
Social Security
Medicare
Health Insurance
Retirement Plan
Other Deductions
Total Deductions

Net Pay: [$4,650]

Bank Account Information

• Bank Name: [XYZ Bank]

• Bank Account Number: [1234567890]

• Routing Number: [987654321]

Acknowledgment

I hereby acknowledge that the above information is accurate to the best of my knowledge and that I have reviewed this Payroll Allocation Form.

Employee's Signature:

___________________________
Date: [Month Day, Year]

Supervisor's Approval

I certify that the earnings and deductions listed above are accurate and have been reviewed and approved.

Supervisor's Signature:

____________________________
[Your Name]
Date: [Month Day, Year]

HR Department Use Only

• Processed By: [Your Name]

• Date Processed: [Month Day, Year]

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