Wage Subsidy Claim Form | Make A Change Canada

Employer Name:

Name of Contact Person:

Telephone Number:

Email Address:

Employee/Worker Name:

Please enter the employee's/worker's name for this claim.

Period Claim Covered From:

Please enter the first date of the claim period or the first day worked.

Period Claim Covered To:

Please enter the last date of the claim period or the last day worked.

Claim Amount for Period:$

Please enter the total amount of your claim. If vacation pay applies, please include in the total claim.

Details, calculation, or total hours worked during the period (related to Schedule B):

Please enter details to support our claim amount. The claim amount and hours worked should equal amounts in the employer agreement, Schedule B. If there is any variation, please provide an explanation.

Time Sheet or Invoice from Worker:

Please upload the worker's time sheet (or all applicable workers' time sheets if claiming for more than one worker) for the current claim period. Acceptable file formats (2 MB max size): PDF, image, document, spreadsheet
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx odt xls xlsx ods.

Job Activities:

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?

Yes