Public Works and Government Services Canada
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Supplementary Claim

To be used for recording costs in support of form PWGSC-TPSGC 1111.


Description: (Expenditures must be claimed in accordance with the basis and/or method of payment of the contract) Current Claim Previous Claims Total to Date
(A + B)
(A)
3 decimal

Tax
Rate a
(B)
3 decimal

Tax
Rate b

Table note a Enter the applicable tax rate, for example 5 or 14 or 14.975 (do not use comma).
Table note b Enter the applicable tax rate, for example 5 or 14 or 14.975 (do not use comma).

Description 1
% %
Description 2
% %
Description 3
% %
Description 4
% %
Description 5
% %
Subtotal
Applicable taxes
Total