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2700, 10020-100 Street NW, Edmonton, AB T5J 0N3 Phone: (780) 423-4764 ? Fax: (780) 420-0651? www.cpsa.ab.ca Statement of Services Rendered Service Performed By: (Please Print) *Name Facility # Address.

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How to fill out the Statement Of Services Rendered - Expense Form online

Filling out the Statement Of Services Rendered - Expense Form online can streamline the process of claiming expenses and honorarium payments. This guide will provide you with clear instructions on each section of the form to ensure a smooth submission.

Follow the steps to complete your form successfully.

  1. Select the ‘Get Form’ button to access the Statement Of Services Rendered - Expense Form and open it in an editor.
  2. Begin by entering your name in the designated field under 'Service Performed By'. Ensure that you print the name clearly.
  3. Fill in your Facility Number and provide the address of the payee, including postal code. This information is essential for payment processing.
  4. Choose your preferred payment method by selecting either 'Electronic Funds Transfer (EFT)' or 'Cheque'. If you are using EFT, you may need to indicate whether this is a new or existing arrangement.
  5. If you are claiming expenses, indicate whether the expenses are for yourself or a professional corporation. If applicable, provide your Social Insurance Number (SIN) or the GST number for the corporation.
  6. In the section labeled 'Nature of Services Rendered', fill in the committee name or description along with the date(s) services were provided.
  7. List all claimed expenses in their respective fields (Air Fare, Car, Taxis, etc.) and ensure you attach any receipts required to support these claims.
  8. Calculate the total expense claim at the bottom of this section and input that amount.
  9. If applicable, complete the 'Claim For Honorarium' section by entering the number of meeting days and your rate per day to compute the total honorarium claim.
  10. Sign the form where it indicates *Signature of Claimant*, confirming that all information provided is accurate.
  11. Once all sections are completed, you can save your changes, download the form for your records, or print and share the copies as needed.

Complete your Statement Of Services Rendered - Expense Form online today for an efficient claims process.

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