PAYROLL CANADA - DATA COLLECTION FORM
                     -------------------------------------
   (Employee Information may be entered directly on the screen, however this
        form may be helpful as a worksheet to collect that information)

SIN                     EMPL NUM                   PREV EMPL NUM

SURNAME                            FIRST NAME

STREET

TOWN

PROVINCE                            POST CODE          PHONE

SEX      YR BORN         MO BORN       DAY BORN       AGE       MARITAL

OCCUPATION                              EMPLOYEE STATUS

LAST SALARY REVIEW (yyyy/mm/dd):     /  /      NEXT REVIEW DUE:     /  /

HEALTH PLAN NUMBER               CALC PREM. AS      SKIP AUTO. CALC.

PAY METHOD      SALARY TERRITORY      SALARY LEVEL      SALARY PERFORMANCE

ANNUAL SALARY                   HOURLY RATE               PAY FREQ.

OVERTIME PERMITTED

VACATION ACCRUAL P'CENT          VACATION ALLOW         VACATION TAKEN

SICK ACCRUAL P'CENT               SICK ALLOW            SICK TAKEN

START YEAR          START MO         START DAY

END YEAR            END MO           END DAY          REASON TERMINATED

PENS PLAN REGN            TAX AS NON-RESIDENT TEMPORARY WORKER (15% RATE)

TAX AS CDN.RESIDENT NOW OUTSIDE CANADA FOR >50% OF THIS YEAR (80% CREDIT)

TAX SET UP INFORMATION: (Enter $ amounts, TD3 is per pay, others are Annual)
======================

EXTRA TAX TD3            NET CLAIM TD1              PRESCRIBED AREA

AUTH. CHILD CARE, ALIMONY, ETC              OTHER AUTH. TAX CREDITS

   (Use "AUTH." entries on above line only if authorised by the District
    Taxation Office. Be extra careful with "OTHER AUTH. TAX CREDITS"  as
    it has a far bigger effect on tax deducted than the others.)

LABOUR-SPONSORED VENTURE CAPITAL (**FULL** PURCHASE THIS YEAR $)

COMMENTS:
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