Notice of Assignment of Wages

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Notice and Direction TO: Name of Employer TAKE NOTICE that the undersigned employee has made an assignment of wages in favour of Name of Assignee (Person to whom employee is indebted) (the "Assignee"). Until further notice by the Assignee, you are hereby authorized and directed to make all future payments of salary, wages, bonuses, commission, compensation or other remuneration (collectively the "Wages") owing to the undersigned to the Assignee as follows: Name of Assignee Address of Assignee Telephone No. of Assignee NOTE: Local laws may limit the amount or percentage of Wages which an employee may lawfully assign. We suggest that you confirm this amount or percentage before remitting payment to the Assignee. Dated: Witness Name of Employee

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