Request for Statement of Earnings

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					                                                    Request for Statement of Earnings
                                                    (Lost PAYG payment summary or group certificate)

Current employees now have access to current and previous PAYG Payment Summaries through
eduPay Employee Self Service (ESS). Copies can be obtained using ESS. Requests sent to HR will
continue to incur a cost to the employee.

 Employee Details
 Family Name

 First Name                                        Second Name

 Employee ID Number


 Current Mailing Address




 Request Details

 Please supply me with a Statement of Earnings for lost PAYG Payment Summary/Group Certificate for
 the following financial year/s.
  1                          2                        3                                  4

  5                          6                        7                                  8

 Employee
 Signature



 Payment Details (a charge of $27.45 per financial year requested applies)

   Deduct $ ________ from my next available fortnightly pay (only available to employees currently being
paid)
   Cheque/Money Order attached for $ _________ (payable to Department of Education & Early Childhood
                                                Development)
   Charge my credit card as follows.

 Cardholder’s Name :                                                            MasterCard                (please tick)
                                                                                Visa
 ___________________________________________
 (please print)

 Card Number                                                                            Expiry Date _____/_____

 Cardholder’s Signature:                                                                           Amount
                                                                    Date ____/____/____
 ________________________________________                                                          $____________

Mail or fax requests to:     Payroll Services, Department of Education and Early Childhood
                             Development, GPO Box 4367 Melbourne, 3001.
                             Fax: (03) 9637 2850
                             Telephone enquiries to: (03) 9637 3278 or (03) 9637 3279



                                                                                              Last updated 11 May 2012

				
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