Community Preceptor Payments – Office-Based Preceptors
Payment Details Forms
These payment detail forms are for those eligible office-based preceptors. For more information regarding eligibility please review the Community Preceptor Funding Program – Guidelines.
Forms can be scanned and emailed to email@example.com.
There are two options, each with different requirements:
I have a registered Medicine Professional Corporation, Partnership or Business:
- Complete Option #1: in the Attestation Form re: “MPC Payment Details”
- If you do not have an HST number, we would still need Option# 1 to be filled out minus the HST number.
- Also, please complete and return “Small Supplier Certification” portion of the attestation form. This form certifies that your corporation is not required to submit HST.
I do not have a Medicine Professional Corporation or Registered Company:
- Complete Option #2 in the Attestation Form re: “T4A”.
- Also, please complete and return “Small Supplier Certification” portion of the attestation form.
- Provide a “VOID” cheque for an account with chequing privileges.