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ADCY - Wage Subsidy Claim Form

Claim Submission Instructions:

1. A claim for wage subsidy must be submitted separately for an intern at least three (3) days in advance of each scheduled disbursement.
2. All claims must include *both a timesheet completed by the employee and the corresponding pay slip. The employee timesheet must be prepared by the employee and show the actual hours worked each day. The pay slip must show the actual number of hours worked and match the total hours in the employee timesheet for the claim period. Under the DS4Y verification rules, and in accordance with the Employer Agreement and Participant Information Form submitted by the employer to DS4Y, Make A Change Canada cannot accept claims that are based on a salary method of payroll. Incomplete or incorrect claims will not be processed.

Please enter the employee's name for this claim.
Please enter the first date of the claim period or the first day worked.
Please enter the last date of the claim period or the last day worked.
Total Regular Hours Being Claimed:
Select the number of hours worked by the employee (from timesheet). Total hours claimed cannot exceed the amount listed in your employer agreement and PIF.
Total Statutory/Public Holiday Hours or Gross Holiday Pay Being Claimed:
Select the number of hours applicable for stat holidays or the total amount of holiday pay due for the employee. Total hours claimed cannot exceed the amount listed in your employer agreement and PIF. If there was no stat holiday or no amount payable, select 0.
$
Please enter the total amount of your claim. Refer to your employer agreement for details of eligible amounts.
Please enter details to support your claim amount. The total claim amount and hours claimed must not exceed amounts listed in the employer agreement and Schedule A of the employer agreement. If there is any variation, please provide an explanation.
Please upload the employee's timesheet and pay slip, along with any other related documents such as e-transfer confirmations. Maximum of 4 documents can be attached per claim.
Acceptable file formats (1 MB max size): PDF, image, document, spreadsheet
Files must be less than 1 MB.
Allowed file types: gif jpg jpeg png pdf doc docx odt xls xlsx ods.
Provide a summary of the job activities that have taken place since last claim form; include employee’s progress and any issues if applicable.
Final Claim?
The employer hereby certifies the above information is in accordance with the Terms and Conditions of the Independent Contractor Agreement.
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