This form is for use in those situations where an employee chooses to assign and transfer his wages from employment to another party. The form includes language limiting the amount of the assignment to the maximum amount permitted by law.

This form includes special formatting features to assist you in completing the agreement.

This form can be used in the following provinces: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan and Yukon.