CORP/EMP 34 v.2 - Doncaster and Bassetlaw Hospitals NHS ...

CORP/EMP 34 Version 2
APPENDIX F – REQUEST FOR HARDSHIP LOAN PAYMENT
PART A – FOR COMPLETION BY THE CSU or DIRECTORATE MANAGER
The following member of staff has requested a Hardship Loan from the trust
Employee Name: __________________________Department: ______________________________
Designation: ____________________________ ESR ID Number: ___________________________
Please state the reason for requesting a Hardship Loan and the amount requested:-
Manager Name:___________________ Signature: ___________________________________
Designation: _____________________________ Date: ________________________________
PART B – TO BE COMPLETED BY EMPLOYEE
I have exhausted all other sources of funding, including my bank before approaching my line manager to
obtain a loan from the trust.
I understand that if approved, the loan will be deducted in full from my next salary payment
Employee’s signature: ____________________________ Date: __________________________
PART C – TO BE COMPLETED BY THE ESC AUTHORISING MANAGER
Received by Employee Services on (date) ___________ at (time) _______________________
Approved: YES / NO (please circle)
Date: ______________________________
Signature of Authorising Manager:
____________________________________________________________________________
Name of Authorising Manager:
____________________________________________________________________________
Reason for non-approval (if applicable - ESC manager to inform CSU/Directorate manager):
________________________________________________________________________
Processed by Employee Services on (date)___________at _________________________
Due to credit employees bank account on (date)__________________________________
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