Are you looking for more information about WCB Form C936? Have you heard about this form, but are unsure of what it is and how it affects your business? This blog post will provide an overview of WCB Form C936 and delve into the complexities behind its purpose. It'll offer comprehensive explanations on the various components of the form, discuss who exactly must submit it, how to fill out sections accurately, deadlines associated with submitting the form, as well as any fees or penalties applied for late submission. So read on to make sure your business is in compliance with all its obligations when completing a WCB Offeror's Submission Form!
| Question | Answer |
|---|---|
| Form Name | Wcb Form C936 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | T4A, WCB, wcb c936, EDMONTON |
C936
PERSONAL ATTENDANT'S WAGE LOSS
9912 - 107 STREET
PO BOX 2415 EDMONTON AB T5J 2S5 FAX:
Claim Number:
Personal Attendant's Social Insurance #:
Personal Attendant's Name: (Surname) |
(First Name) |
(Initial) |
Address Street |
City/Town |
Province |
(Postal |
Code) |
Telephone Number
( )
Note: WCB requires a personal attendant's Social Insurance Number in order to process T4A slips
The above named personal attendant is required to assist a WCB claimant to attend an appointment (i.e. medical examination, DRDRB review meeting or appeal hearing) in relation to their claim. WCB can pay a wage loss allowance if the personal attendant has a loss of earnings as a result of leaving work to attend the appointment.
TO ALLOW US TO PROPERLY REIMBURSE THE PERSONAL ATTENDANT, PLEASE RETURN THE COMPLETED FORM TO THE ADDRESS OR FAX NUMBER NOTED ABOVE.
1. |
Will you pay the personal attendant directly for the time missed to attend this appointment: |
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Yes |
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No |
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If other, provide details: |
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2. |
Is the personal attendant self employed? |
If yes, the personal attendant must supply WCB with income and expenses for the period of one month prior |
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Yes |
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No |
to appointment date. |
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3. |
Time missed from work to attend appointment(s): |
Hour or |
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Day or |
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Other (eg., trips) |
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4.Date(s) missed from work:
5. |
Rate of pay: $ |
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per |
Hour |
Day |
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Month |
Yearly Gross |
Other |
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Explain other
6.Number of hours worked per week/shift:
7. |
Circle the personal attendant's usual day(s) OFF |
S M T W T F S |
or shift cycle if applicable: |
8.Date shift cycle commenced:
(Year / Month / Day)
9. Employer's Name: |
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Telephone Number |
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Address |
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Street |
City/Town |
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Province |
(Postal Code) |
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Contact Name (Print):
Contact Signature:
Official Title:
Date: |
(Year / Month / Day) |
C - 936 REV APR 2008