Tuition Fee Benefit Disbursement Authorization
Employee Information
Employee Name:
Employee ID:
Department:
Contact Number:
Eligible Dependent Information
Name
Relationship
Date of Birth
Institution Name
Tuition Benefit Details
Academic Year/Semester:
Program of Study:
Amount Requested:
Authorization
I hereby authorize the disbursement of the tuition benefit as per the information provided above.
Employee Signature:
Date:
For Office Use Only
Approved By:
Date:
Remarks: