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Supplementary Claim

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Supplementary Claim (PDF  81KB)
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To be used for recording costs in support of form PWGSC-TPSGC 1111.

Contractor's Name and Address:

Claim No.:

Date:

File No.:

Contract Serial No.:

Financial Code(s):

  Current Claim Previous Claims Total to Date
(A + B)
Description: (Expenditures must be claimed in accordance with the basis and/or method of payment of the contract) (A) Tax
Rate		 (B) Tax
Rate
           
           
           
           
           
Subtotal:
          
Applicable taxes:
          
Total:
          
Contractor's GST/HST No.:
Contractor’s QST No.:
Date Modified: 2013-05-03

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