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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and Social Insurance Number (SIN) at the top of the form. Ensure that this information is accurate, as it will be used for verification.
In the section labeled 'HIGHEST CALENDAR WEEKS OF INSURABLE EARNINGS IN THE LAST 52 WEEKS', provide the start date (from Sunday) for each week you are reporting. You can list up to 22 weeks.
Next, enter the name of your employer for each corresponding week. If you had multiple employers, make sure to list them all.
Finally, input your gross insurable earnings for each week listed. Remember, this should include all salary and any statutory holiday pay but exclude termination payments.
Once all fields are completed, review your entries for accuracy before signing and submitting the form.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (105 Votes)

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