Form YG4984 "Statutory Declaration - Labour, Apprentice, Youth, Materials Incentive Rebate" - Yukon, Canada

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Download Form YG4984 "Statutory Declaration - Labour, Apprentice, Youth, Materials Incentive Rebate" - Yukon, Canada

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YUKON BUSINESS INCENTIVE POLICY FOR CONSTRUCTION
STATUTORY DECLARATION
YUKON LABOUR, APPRENTICE, YOUTH AND/OR MATERIALS INCENTIVE REBATE CLAIM
IN THE MATTER OF
a contract bearing no. __________________________________ between the Government of Yukon
and __________________________________________________________________________________
FULL NAME OF CONTRACTOR
for ___________________________________________________________________________________
DESCRIPTION AND LOCATION OF THE WORK
dated the _______ day of _______________________ 20 ______
AND
IN THE MATTER OF
a Business Incentive Program rebate claim covering Yukon labour, apprentices, youth and/or
Yukon materials; in work done and/or Yukon manufactured materials incorporated into work
done thereunder:
from the _______ day of _______________________ 20 ______
to the _________ day of _______________________ 20 ______
by the contractor/subcontractor _________________________________________________________
FULL NAME OF CONTRACTOR/SUBCONTRACTOR
TO WIT:
I, ___________________________________, of______________________________________________
FULL NAME OF DECLARANT
DECLARANT’S ADDRESS
do solemnly declare:
1. That I am ___________________________________________________________________________
DECLARANT’S TITLE/POSITION WITH THE CONTRACTOR OR STATE THAT THE DECLARANT IS THE CONTRACTOR/SUBCONTRACTOR
and as such have a personal knowledge of the contract and of the facts and matters, including
the Business Incentive Program rebate claim for Yukon labour, apprentices, youth and/or
material declared herein, said personal knowledge resulting from, among other things, an
examination of the books and records of the contractor/subcontractor.
2. That, all labour, including apprentice and youth labour, listed in this claim is valid as stated.
The wages paid to each employee on the above named project are in compliance with the
Fair Wage Schedule wage rates established pursuant to the Employment Standards Act.
3. That, where materials are listed in this claim, they were manufactured in Yukon, and are
listed in the applicable rebate schedule.
4. That, where materials are listed in this claim, they were on site and were used in this work,
and that any materials not used have been deducted.
5. That this Business Incentive rebate claim is valid and correct.
And I make this SOLEMN DECLARATION conscientiously believing it to be true, and knowing that
it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.
Declared before me at ____________________________________ this _______ day of _______________________ 20 ______.
___________________________________________________
___________________________________________
Signature of notary public, in and for the Yukon Territory
Signature of declarant
___________________________________________________
Print name of notary public, in and for the Yukon Territory
(Clearly state authority for receiving solemn declaration)
Notice: If this declaration is not complete in every detail, it may be returned for completion and payment will be delayed.
YG(4984EQ)F1 Rev.12/2018
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YUKON BUSINESS INCENTIVE POLICY FOR CONSTRUCTION
STATUTORY DECLARATION
YUKON LABOUR, APPRENTICE, YOUTH AND/OR MATERIALS INCENTIVE REBATE CLAIM
IN THE MATTER OF
a contract bearing no. __________________________________ between the Government of Yukon
and __________________________________________________________________________________
FULL NAME OF CONTRACTOR
for ___________________________________________________________________________________
DESCRIPTION AND LOCATION OF THE WORK
dated the _______ day of _______________________ 20 ______
AND
IN THE MATTER OF
a Business Incentive Program rebate claim covering Yukon labour, apprentices, youth and/or
Yukon materials; in work done and/or Yukon manufactured materials incorporated into work
done thereunder:
from the _______ day of _______________________ 20 ______
to the _________ day of _______________________ 20 ______
by the contractor/subcontractor _________________________________________________________
FULL NAME OF CONTRACTOR/SUBCONTRACTOR
TO WIT:
I, ___________________________________, of______________________________________________
FULL NAME OF DECLARANT
DECLARANT’S ADDRESS
do solemnly declare:
1. That I am ___________________________________________________________________________
DECLARANT’S TITLE/POSITION WITH THE CONTRACTOR OR STATE THAT THE DECLARANT IS THE CONTRACTOR/SUBCONTRACTOR
and as such have a personal knowledge of the contract and of the facts and matters, including
the Business Incentive Program rebate claim for Yukon labour, apprentices, youth and/or
material declared herein, said personal knowledge resulting from, among other things, an
examination of the books and records of the contractor/subcontractor.
2. That, all labour, including apprentice and youth labour, listed in this claim is valid as stated.
The wages paid to each employee on the above named project are in compliance with the
Fair Wage Schedule wage rates established pursuant to the Employment Standards Act.
3. That, where materials are listed in this claim, they were manufactured in Yukon, and are
listed in the applicable rebate schedule.
4. That, where materials are listed in this claim, they were on site and were used in this work,
and that any materials not used have been deducted.
5. That this Business Incentive rebate claim is valid and correct.
And I make this SOLEMN DECLARATION conscientiously believing it to be true, and knowing that
it is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.
Declared before me at ____________________________________ this _______ day of _______________________ 20 ______.
___________________________________________________
___________________________________________
Signature of notary public, in and for the Yukon Territory
Signature of declarant
___________________________________________________
Print name of notary public, in and for the Yukon Territory
(Clearly state authority for receiving solemn declaration)
Notice: If this declaration is not complete in every detail, it may be returned for completion and payment will be delayed.
YG(4984EQ)F1 Rev.12/2018
Print
Clear