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Elder_Honorarium_Form

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					       Elder Honorarium Payment -                                                                   Appointment/Pay Action

DEPARTMENT NAME                                                              DEPT #
PERSONAL INFORMATION
Full Legal Name:
                                                                             Person ID No.:
Surname

                                                                             Date of Birth:
First Name

                                                                             Previous Name(s)
Middle Name(s)

Correspondence Address Information:                                          Social Insurance No.:


Address                                                                      SIN # verified by Dept./Faculty


City
                                                                                         Please note that we collect the Social
Prov/State
                                                                                      Insurance Number and the Date of Birth for
Country
                                                                                    identification purposes ONLY. For this type of
                                                                                             payment, they are not required.
Postal Code

Phone                              Business

ATTRIBUTES AND PAYMENT INFORMATION


Start Date:
                                     yyyy/mm/dd

End Date:                                                                          Amount:           $
                                     yyyy/mm/dd                                                                       (total amount)

                                                                                   One time Payment:
Speed Code:

                                                                                    ALL payments processed with this form should be
Account No.:                                                                                     one-time payments.


PREPARED BY
Date                                           Prepared By                                                       Phone

AUTHORIZATION AND APPROVALS
Authorization and Approvals are in accordance with the University of Alberta Signing Authority Policy and Signing Authority and Approval procedures.
Refer to U of A Policies and Procedures Online (UAPPOL) www.uappol.ualberta.ca.



Date                         Authorized By                                         Authorized By
                                                           (printed name)                                                   (signature)



Date                         Authorized By                                         Authorized By
                                                           (printed name)                                                   (signature)

                             Internal Control                                      Internal Control
Date                         Approval                                              Approval
                                                           (printed name)                                                   (signature)

                             Internal Control                                      Internal Control
Date                         Approval                                              Approval
                                                           (printed name)                                                   (signature)
COMMENTS




DISTRIBUTION:      Original: Human Resource Services                 One copy: Department                   One Copy: Principal Investigator
                                                                                                                                          May 26, 2011
n
                                                                       Elder Honorarium Form

                                      This form is to be used for the purposes of providing a gift to an aborginal Elder or Know


Department Name - Enter department name
Department ID - Enter department ID

Person ID No. - All information in the Payroll/ HR system is processed by PERSON ID numbers. If the individual was or is a stu
individual was previously employed at the university a Person ID number would have been assigned. Use Search Match in PISC
done a thorough and complete search prior to creating a Person ID number
Social Insurance Number - for this type of payment ONLY, we do not require a Social Insurance Number unless it is offered.
Correspondence Address - The Home Address is required to ensure staff receive their T4A's
Phone - Indicate Residence and Business Phone numbers
Date of Birth - for this type of payment ONLY, we do not require a Date of Birth unless it is offered.

Speed Code and Account Number - the payment cannot be processed without a complete and active speed code

Authorization and Approvals are in accordance with the University of Alberta Signing Authority Policy and Signing Authority and
Procedures Online (UAPPOL) www.uappol.ualberta.ca
rarium Form

a gift to an aborginal Elder or Knowledge-Sharer ONLY.




ers. If the individual was or is a student at the university indicate the student number. If the
signed. Use Search Match in PISCES to find the Person ID number. Ensure you have

ance Number unless it is offered.




and active speed code

y Policy and Signing Authority and Approval procedures. Refer to U of A Policies and

				
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