HUMAN RESOURCES ACTION FORM

Employee Details

Employment Number: A00225082

Beg
Last Name: ____________________________________ Manisha
First Name: ___________________________________
Mainaaz
Other Names: __________________________________ Miss
Courtesy Title: _______________________________
09 04 1999
Date of Birth: _____/______/_______ ☑ (from your contract)
Start Date: _______/______/_______
☑ (from your
End Date: ______/______/________ contract) ✘ ✘
Review Date: _______/______/_______

Gender: Male Single

Marital Status: ________________________________
Female ✔ (if applicable)
Marriage Date: ________________________________
PAL Leader
Job Title: _____________________________________ MN13008481V
FNPF Number: ________________________________
024768203
TIN: __________________________________________
✘
Salary: per annum $_____________________________ 10.00
Wage: per hour$_______________________________

Personal Details
Fijian
Nationality: _____________________________________
✘
D/L Country of Issuance: __________________________ ✘
D/L Number: ___________________________________
✘
D/L Class: _______________________________
NB: D/L –Driving License

Identification
☑ (if applicable)
Passport Number: ______________________________ ✘
Work Permit Number: _________________________
?
Country of Issue: _______________________________ ?
Issue Date: _________________________________
?
Issued Date: _______/_______/_________ ?
Expiry Date: ______/______/__________
?
Expiry Date: _______/_______/_________

Postal Residential
PO Box 4712, Samabula/ CO Munabar Beg
Address: ____________________________________ 8 miles makoi
Address: __________________________________________
☑
____________________________________ __________________________________________
_____________________________________ __________________________________________
_____________________________________ __________________________________________
_____________________________________ ___________________________________________
Full-time Appointment Contact Details: Part-time Appointment Contact Details:
9835681
Home Number: ______________________________ ☑ / your mobile number
Work Number: _______________________________
2571794
Mobile Number: ______________________________ ✘
Extension #: _____________________________________
✘
Fax: _______________________________________ A00225082@student.fnu.ac.fj
Work E-mail: ________________________________
m80093227@gmail.com
E-mail: _____________________________________

Citizenship
Fiji
Country of Citizenship: ____________________________ ✘
Dual Citizenship Status/ Description: _________________

✘
Work Permit #: ____________________________ ✘
Work Permit Validity: ______________________________

Next to Kin
Chandra
Last Name: ___________________________________ Saleshni
First Name: _______________________________________
Mother
Relationship Type: _____________________________ Kamal
Other Name: ______________________________________
14/02/1974
Date of Birth: _________________________________ 8 miles makoi
Residential Address: ________________________________
Gender: Male _________________________________________
Female ✔ _________________________________________
_________________________________________
9835681
Home Number: ______________________________ ☑
Country: __________________________________________
☑
Office Phone: _______________________________ PO Box 4712, Samabula/CO Munabar
Postal Address: ____________________________________ B
☑
Mobile Number: ______________________________ __________________________________
___________________________________
___________________________________

Bank Details BSP Suva

Bank Account Details: Bank: ______________________________ Branch____________________________
Manisha Mainaaz Beg
Account Name: _________________________________ 81533182
Account#___________________________________

Second Bank Account may be used if approved by Payroll at a cost: N.B. The amount deposited into this account will
be the same each week/fortnight.

✘ ✘
Bank Account Details: Bank: ______________________ Branch____________________________
✘
Account Name: _________________________________ ✘
Account#________________________________
✘
Amount: ______________________________________
DEDUCTIONS Union Fees:
✘
Membership Detail: _____________________________________________________________________________

Deduction: Fortnightly Weekly

✘
Amount: $_________________________

Insurance (Life/ Medical): ✘(leave all of this section)

Insurance Provider: _____________________________________________________________________________
✘
Policy #: _________________________________________

Deduction: Fortnightly Weekly

✘
Amount: $_________________________

(leave all of this section)

Other (Specify): _______________________________________________________________________________

Deduction: Fortnightly Weekly ✘

Amount: $_________________________

SIGNATURES
Authority: I hereby authorise the Division of Finance (Payroll) to deduct fees as instructed and direct credit my
salary / wage into the nominated bank account(s). I certify the above details are true and correct.
Manisha Beg
Employee Name: _______________________________________________

☑ 24 07 2023
Employee Signature: ________________________ ( Date )_____/_______/________

THIS BLOCK IS FOR INTERNAL USE ONLY

✘
Signature: _________________________________________ ( Date )______/_____/________

Manager Compensation & Benefits C& B Specialist C&B Analyst