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FEDERACIÓN CENTRO UNIÓN DE TRABAJADORES DEL SEGURO SOCIAL

DE SALUD - ESSALUD DEL PERÚ

Inscrita en el Tomo 7 del Registro de Asociaciones, Asiento 1, Fojas 341 de los Registros Públicos de Lima de fecha 21 de Junio de 1963 y Registrado ante el Ministerio de Trabajo y Promoción del Empleo mediante

Registro Nº 51501-06-DRTPELC/DPSC/SDRG/DRS, fundado el 08 de Agosto de 1945

UNION NETWORK INTERNATIONAL INTERNACIONAL DE SERVICIOS PUBLICOS

S O L I C I T U D D E D E S C U E N T O

Pasaje Miguel de los Ríos Nº 149 3er. Piso, La Victoria - Lima - Perú Teléfono: 433-1249 Telefax: 330-3862www.fedcut.org E-mail: fedcut@fedcut.org

FED-CUT

Yo,

debidamente identificado(a) con D.N.I. Nº

servidor(a) de

Código de Planilla Nº

SOLICITO: DESCUENTO POR PLANILLA UNICA DE PAGOS.

SEÑOR GERENTE CENTRAL DE RECURSOS HUMANOS DEL SEGURO SOCIAL DE SALUD

(ESSALUD)S.G.C.

Que, de conformidad con los dispuestos por el Decreto Supremo Nº 114-2002-PCM,

autorizo expresamente que se me descuente el 1% de mis Remuneraciones totales mensuales

incluyendo cualquier Bonificación cual fuera su denominación, por concepto de Cotización gremial a

favor de la FEDERACION CENTRO UNION DE TRABAJADORES DE ESSALUD, y deberá ser

distribuido 40% Federación CUT y 60% para nuestra Base Sindical; así mismo autorizo que se me

descuente las cuotas extraordinarias denominadas BESFA-CUT, BER-CUT y cualquier otro

descuento que señale el Consejo Directivo Nacional de la FED-CUT.

Para tal efecto, declaro bajo juramento que los datos consignados corresponden

estrictamente a la verdad, que mi firma es la misma que uso en todos mis documentos, haciéndome

pasible a las sanciones a que hubiere lugar en caso de faltar a la verdad.

Lima, de del 201.........

______________________________________ Firma

Huella Digital

Fecha de ingreso a la Institución: pertenenciente al Régimen Laboral:

276 728 1057

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