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{"sheet":"Sheet1","index":0,"n_rows":56,"n_cols":9,"rows_kept":56,"cut":false,"hidden":false,"merged":[[0,0,3,10],[17,0,17,4],[17,5,18,10]]}
["Non-Employee Payment Request"]
[]
[]
[]
[]
["Cheque:  ","Mail","Return to ________________",null,"or ","International wire transfer:  Specify account currency"]
["(If no selection is made the cheque will be mailed)",null,null,null,null,"(Complete $ attach  International Wire Request Form, available on the Finance website)"]
["Direct Deposit:",null,"Ensure the Direct Deposit form is included"]
[]
["Issuing Department Information:"]
["Department Contact Name:",null,null,null,null,null,null,"Phone:"]
["Department:"]
[]
["Payee Personal Information with SIN needed unless reimbursement request with original receipts"]
["First Name:",null,null,"Last Name:"]
[]
["Social Insurance Number (SIN): if not provided, form will be returned to department"]
[null,null,null,null,null,"*SIN is not required for reimbursement requests with original receipts attached"]
[]
[]
["Permanent Address (for purposes of mailing T4A/T4A-NR-Department address not accepted):"]
["Street No. and Address:",null,null,null,null,"Apt Number:",null,null,"City:"]
["Province/State/Territory:",null,null,null,null,"Postal Code:",null,null,"Country:"]
[]
[]
["Additional Information (For Non-Residents only):"]
["Individual Tax or Foreign Social Security",null,null,null,"Number of days individual in Canada in Current Tax Year",null,null,null,"Date(s) work performed:"]
["Number:",null,null,null,"or Work performed outside Canada"]
[]
[]
["Residents-Non Employment Payments",null,null,null,"or","Non-Residents - Non employment Payments"]
["These payments will be reported on a T4A",null,null,null,null,"Where work is performed in Canada, 15% withholding tax will be deducted as "]
[null,null,null,null,null,"per Revenue Canada Taxation Act and the payment will be reported on T4A-NR "]
[null,null,null,null,null,"**If the Regulation 105 Waiver Application is completed and submitted with this "]
["Guest Lecturer/Speaker",null,null,null,null,"form, the withholding tax will not be deducted."]
[null,null,null,null,null,"(105 Waiver Application is available on Finance Website)"]
["Honorarium"]
[null,null,null,null,null,"Guest Lecturer/Speaker"]
["Indigenous Honorarium"]
[null,null,null,null,null,"Honorarium"]
["External Reviewer/Examiner"]
[null,null,null,null,null,"Other"]
["Other"]
[]
["Description of work performed (or attach supporting documentation):"]
[]
[]
[]
[]
["Department Account:",null,null,null,null,"Amount:",null,null,"Currency:"]
[]
[]
["Authorized By:"]
["Name:",null,null,"Signature:",null,null,null,"Date:"]
[]
["Submit the completed original to Accounts Payable"]

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[null,"Currency"]
[]
["Mail","CDN$",0]
["Pickup in AP","US$",1]
["Direct Deposit","Euros",2]
[null,"Peso",3]
[null,"Pounds",4]
[null,"Renminbi ",5]
[null,"Rupees",6]
[null,"Yen",7]
[null,"Other (Specify)",8]
[null,null,9]