Berlitz Japan Union Dues Checkoff Authorization Form

As per the agreement between Berlitz Japan and the General Union, I consent to the company deducting my General Union union dues from my salary every monthly payday. When there is a change to the deduction amount or a cancellation of the deduction, I will inform the General Union by the end of the month.

Today's Date

Full Name

Employee Number

Language Centre:
—Please choose an option—NagoyaAbeno/TennojiUmedaSenrichuoKyoto Eki MaeSannomiyaHiroshimaHakata Eki MaeOther

By selecting the checkbox and providing your name again and email below, you are consenting and agreeing to the terms of the dues checkoff.

I consent

Full Name

Email

If you have any trouble with this form, or do not receive an email confirmation, please email union@generalunion.org

After submitting this form, union dues will be deducted from the following month from your monthly salary