Appendix 4

Appendix 4

(Sample - for reference only)

Receipt for Payments upon Termination / Expiry of Contract

I, , ID / Passport No. , receive the following payments from my

employer on (date) *in cash / by cheque/by bank autopay.

1. Wages (from to ) $ inclusive of payment for the following :

(a) statutory holiday(s) (dates:                       )

(b) annual leave (from                       to                       )

(c) sick leave (from                       to                       )

(d) others (please specify)

　
2. Food allowance (from                       to                       )
$

　
3. Wages in lieu of notice
$

　
4. Untaken annual leave pay (                       days)
$

　
5. Long service payment/severance payment
$

　
6. Food and Travelling allowance
$

　
7. Payment in lieu of air-ticket / return air-ticket of                       (Airline)
　

　
8. Others
(a)                       $

　 (b)                      $

Signature of Helper:		Signature of Employer:
(Name)	( )	(Name)	( )

Witnessed by (if any)	(Signature):
	(Name) ( )

* delete where appropriate