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Contributions Certificate
Contributions Certificate
Employer's Registration No.
Employer's Business Name
Address
District
Parish
St. Lucy
St. Peter
St. Andrew
St. James
St. Joseph
St. George
St. Thomas
St. John
St. Michael
St. Philip
Christ Church
Contributions Period
Month
Year
Details of Insurable Earnings and Contributions Payable
Earnings Type
Number of Employees
Insurable Earnings
Rate
Contributions Payable
Less Previous Overpayment
Add Previous Shortpayment
Total Amount Payable
Declaration
I declare that the above information is true and correct and the amounts accurately represent the Insurable Earnings for ALL employees.
Signature
Date
MM slash DD slash YYYY
Δ