Protected B when completed
Attestation for owner/managers and/or senior employees (comptroller/VP Finance/CFO)
of an eligible employer applying for the Canada Emergency Wage Subsidy
(position, office or rank)
certify and attest that:
Part I – General
1. All information included in the application is to the best of my knowledge true and complete and is not false or misleading in all material respects.
2. I am the individual who has principal responsibility for the financial activities of the employer.
3. The employer is an eligible employer for the Canada Emergency Wage Subsidy (CEWS) as determined under the CEWS program rules in section 125.7
of the Income Tax Act (the "CEWS program rules').
The employer's qualifying revenue from activities carried on in Canada has declined by the specified amount as compared to their revenue before the
COVID-19 crisis, as determined under the CEWS program rules.
5. The amount of the claim in the CEWS is based on remuneration of employees that were on the employer's payroll during the period being claimed to the
extent required under the CEWS program rules.
6. The claim amount was calculated based on eligible remuneration and does not include excluded remunerations under the CEWS program rules (for
example, stock options, severance payments, etc.).
7. The claim has been reduced by any amount that the employer is claiming under the 10% Temporary Wage Subsidy as described in section 153 of the
Income Tax Act.
8. The employer has and will maintain records for CRA review that demonstrate the revenue reduction, employee remuneration and any other information
required to verify the amount of the CEWS claim. The employer will maintain records for the amount of wages paid to employees from the subsidy, and
report these amounts on its employees' T4 slips and its T4 summary. These records will be made available to the CRA upon request.
9. The employer will repay amounts paid under the CEWS if it is later determined that the eligibility requirements were not met or the amounts were
10. I acknowledge that the CEWS program rules authorize the CRA to publish the names of CEWS applicants.
Part II – CEWS Program Rules Elections
I certify and attest that
A) The employer (together with all required participants in the election under the CEWS program rules) has made one or more of the following elections or
choices (referred to below as "elections") for revenue calculation for the period covered by this application (check all that apply):
a joint election, along with each other member of the group that prepares consolidated financial statements, under paragraph 125.7(4)(a) of the
Income Tax Act (revenue determined on a non-consolidated basis for members of the employer's group).
a joint election, along with each other member of the affiliated group, under paragraph 125.7(4)(b) of the Income Tax Act (revenue determined
on a consolidated basis for the employer's group).
an election under paragraph 125.7(4)(c) of the Income Tax Act (joint venture election).
a joint election, along with each person or partnership with which the employer does not deal at arm's length and from whom the employer
earns all or substantially all of its qualifying revenue under paragraph 125.7(4)(d) of the Income Tax Act (non-arm's length revenue).
an election under paragraph 125.7(4)(e) of the Income Tax Act (cash method).
an election under subparagraph (b)(ii) of the definition "prior reference period" in subsection 125.7(1) of the Income Tax Act (prior reference
an election under subparagraph (a)(ii) or (b)(ii) of the definition "qualifying revenue" in subsection 125.7(1) of the Income Tax Act (election by
registered charity or not-for-profit to exclude government funding).
The employer has not made any of the above elections.
Part III – Attestation Statements
I make this attestation acknowledging that making a false attestation is a criminal offence, and that the CEWS program rules and other rules under the
Income Tax Act contain serious penalties and consequences for intentional or grossly negligent false statements and other misconduct.
(Ce formulaire existe en français.)
I make this attestation in support of my application for Canada Emergency Wage Subsidy in the amount of
(enter amount being requested on Line H of your application).