                     PAYROLL CANADA - DATA COLLECTION FORM
                     -------------------------------------
   (Employee Information may be entered directly on the screen, however this
        form may be helpful as a worksheet to collect that information)


SIN                     EMPL NUM                   PREV EMPL NUM

SURNAME                            FIRST NAME

STREET

TOWN

PROVINCE                            POST CODE          PHONE

SEX      YR BORN         MO BORN       DAY BORN       AGE       MARITAL

OCCUPATION                              EMPLOYEE STATUS

YR LAST REVIEW            MO LAST REVIEW           DAY LAST REVIEW

YR NEXT REVIEW            MO NEXT REVIEW           DAY NEXT REVIEW

PAY METHOD      SALARY TERRITORY      SALARY LEVEL      SALARY PERFORMANCE

ANNUAL SALARY                   HOURLY RATE               PAY FREQ.

OVERTIME PERMITTED FALSE

VACATION ACCRUAL P'CENT          VACATION ALLOW         VACATION TAKEN

SICK ACCRUAL P'CENT               SICK ALLOW            SICK TAKEN

START YEAR          START MO         START DAY

END YEAR            END MO           END DAY          REASON TERMINATED

NON RESIDENT FALSE       NON RES. COUNTRY

STAY <183 DAYS FALSE                PENS PLAN REGN

EXTRA TAX TD3                       NET CLAIM TD1

COMMENTS:
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