EMPLOYEE DECLARATION/ATTESTATION



Department of Tourism, Heritage and Culture

Employee Declaration / Attestation

|I, |      |, (S.I.N.: |      |) , the undersigned |

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|Hereby certify that: |

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|I have filed with Revenue Canada an income tax return for the year ending the 31st day of |

|December |20   |and my current address is: |

|      |

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|And that I have been a resident of |      |for the preceding 12 months. |

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|      | |      |

|Signature of Employee | |Date |

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Attestation of Salary

|I, |      |, the undersigned, hereby certify that: |

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|I performed / will perform the services of |      |

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|for |      |from: |      |to: |      |

| |(name of production) | |

| |

|For the above services, the New Brunswick production company indicated above has paid: |

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| |me as an employee of the production company indicated above |

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| |the company which employs me: |      |

| |(insert name of company) |

| |the company which I own or direct: |      |

| |(insert name of company) |

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|I received a gross salary of $ |      |during that period. |

| |

|I understand that: |      | |

| |(production company) | |

|Will reply on this declaration in applying for final payment, which is subject to government audit, and hereby warrant that the above information is |

|true and correct. |

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|      | |      |

|Signature of Employee | |Date |

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| |

|Note: This attestation must be completed by the production company, signed by the employee and accompany the final report and the final payment claim. |

|Should the employee not be available to sign the attestation, copies of cancelled cheques (both sides) and/or bank payroll deposit form will be |

|required. |

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