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 natali.chin@uoronto.ca.

There are two options, each with different requirements:

Option #1:

I have a registered Medicine Professional Corporation, Partnership or Business:

1. Complete Option #1: in the Attestation Form re: “MPC Payment Details”
2. If you do not have an HST number, we would still need Option# 1 to be filled out minus the HST number.
3. 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.

Option #2:

I do not have a Medicine Professional Corporation or Registered Company:

1. Complete Option #2 in the Attestation Form re: “T4A”.
2. Also, please complete and return “Small Supplier Certification” portion of the attestation form.
3. Provide a “VOID” cheque for an account with chequing privileges.