Wage Subsidy Claim Form

Labour Hire Arrangement:

Wage Info List

Placement

Duration (eg. Weeks 1-4)

Business Name

ABN

Please note:

All Wage Subsidy payments are GST inclusive. Agreed amounts will be reduced by the GST portion if the employer is not registered for GST.
The total value of the wage subsidy for the employment position, together with any concurrent state or territory government wage subsidy, must not exceed 100% of the participants at any point during the wage subsidy agreement period.
The Employer or their Authorised Representative must complete all sections of this form and initial and date any changes made to the information on this form if resubmitted after the original date of claim.
All periods of approved leave recorded in payroll evidence, count towards the Participant’s weekly hours of work requirement.
Approved leave cannot be used to supplement reduced hours of work.

Approved leave is defined as:

Leave agreed to by the Employer at the time the participant requests it; and
Leave that the employer agrees to and must provide under a relevant modern award or as part of minimum employment entitlements set out in the National Employment Services (NES) under the Fair Work Act 2009; or
Leave approved by the Employer that the Participant is entitled to under the relevant award, registered agreement or contract of employment (these leave entitlements cannot be less than the NES).

A Wage Subsidy Participant declining shifts or not urning up to a rostered work hours is not approved leave..
Employer must supply further evidence to support claims involving periods of approved leave on request.

EFT Payment Details:

A Recipient Created Tax Invoice (RCTI) will be provided for your records after calculating the total Wage Subsidy payment due based on the information provided on Page 1 of this document. The RCTI will be sent to the email provided below within 24 hours of payment.

Bank Account Name*

BSB*

Account Number*

Email address for remittance advice and RCTI*

Hidden

Declaration:

I declare the following to be true and correct at the date of each claim listed below.

- I am the person who is authorised to make this declaration.
- As the employer we have complied with the terms and conditions specified in the relevant agreement.
- The employee who is subject to this claim has worked the agreed hours over the duration of the wage subsidy agreement period, including any periods of approved leave whether paid or unpaid.
- All instances of approved leave hours included in claims meet the approved leave definition noted above.
- The wage subsidy placement complies with all employment standards and relevant laws for the employment position under any commonwealth, state and/or territory laws including but not limited to: National Employment Standards – Fair Work Act 2009 (Cth), modern awards, work, health & safety legislation.
- The wage subsidy placement is a sustainable and ongoing position expected to continue indefinitely. This means the Employment is not intended to end when the Wage Subsidy ceases.
- The position has not displaced an existing employee, is not commission based, self-employment or a subcontracted position, (excluding placements with labour hire companies or group training organisations)
- No other State Government or Australian Government Wage Subsidies for the employee who is subject of this claim are being received.
- The information provided in this claim form is true and correct.

Declaration:

I am the person who is authorised to make this declaration.
As the employer we have complied with the terms and conditions specified in the relevant agreement.
The employee who is subject to this claim has worked the agreed hours over the duration of the wage subsidy agreement period, including any periods of approved leave whether paid or unpaid.
All instances of approved leave hours included in claims meet the approved leave definition noted above.
As the employer we intend to continue to employ the employee, who is the subject of this claim on an ongoing basis.
This wage subsidy placement is a sustainable, ongoing position and expected to last more than 26 weeks.
No other State Government or Australian Government Wage Subsidies for the employee who is subject of this claim are being received.
The information provided in this claim form is true and correct.

I am the person who is authorised to make this declaration.

As the employer we have complied with the terms and conditions specified in the relevant agreement.

The employee who is subject to this claim has worked the agreed hours over the duration of the wage subsidy agreement period, including any periods of approved leave whether paid or unpaid.

All instances of approved leave hours included in claims meet the approved leave definition noted above.

The wage subsidy placement complies with all employment standards and relevant laws for the employment position under any commonwealth, state and/or territory laws including but not limited to: National Employment Standards – Fair Work Act 2009 (Cth), modern awards, work, health & safety legislation.

The wage subsidy placement is a sustainable and ongoing position expected to continue indefinitely. This means the Employment is not intended to end when the Wage Subsidy ceases.

The position has not displaced an existing employee, is not commission based, self-employment or a subcontracted position, (excluding placements with labour hire companies or group training organisations).

No other State Government or Australian Government Wage Subsidies for the employee.

The information provided in this claim form is true and correct.

I hereby declare that the information provided is true and correct.*

I hereby declare that the information provided is true and correct.

Is the Employee, who is the subject of this claim, still currently employed in the position detailed in the relevant agreement?

Employee Name*

13 Wk Claim

Yes

If NO, enter employment End Date*

Reason*

26 Wk Claim

Yes

If NO, enter employment End Date*

Reason*

13 Wk Claim:

Employer’s Representative Name

Date of Claim

26 Wk Claim:

Employer’s Representative Name

Date of Claim

Hidden

Note:

NOTE: If employment is terminated prior to the Wage Subsidy Placement End Date, a brief written statement of the reasons why the Participant's employment ended must be provided per Clause 6(c) of the Wage Subsidy Head Agreement.

I hereby declare that the information provided is true and correct.*

I hereby declare that the information provided is true and correct.

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