Monthly Business Expense Report
Monthly Business Expense Report
Monthly Business Expense Report
Income
Sales, Gross Revenue
Less: Returns and Allowances
Less: Provincial Sales Tax (if included in sales)
Add: Other Income - specify (include cash draw)
Gross Income =
Total
Client Consent
I give consent to the Ministry of Social Services to obtain and verify information or documents required to confirm my
eligibility, or the eligibility of family members for social assistance. I understand such information includes needs, money
received from any source, assets, marital status (including common-law relationships), and living arrangements of myself or
family members.
I give consent to any person having such information or documents to release them upon written or verbal request to
employees of the Ministry of Social Services. I understand examples include, but are not restricted to, information or
documents from: Human Resources and Skills Development Canada (Employment Insurance), Workers’ Compensation
Board, Saskatchewan Government Insurance, any bank, credit union or other financial institution, any landlord, and past
employers. I give consent to use my Social Insurance Number and the Health Services Number of myself and my family
members for purposes of determining our eligibility or benefits.
I give consent to the Ministry of Social Services to disclose my/our information to third parties where the information is
necessary to verify and confirm my eligibility for benefits or to assist in providing additional benefits. I understand third
party examples include, but are not restricted to, Canada Revenue agency, The Ministry of Education, the Ministry of
Economy, Workers’ Compensation Board, Canada Pension Plan, Sask Power, Sask Energy, Indian Bands, Public Trustee and
other provincial social assistance programs. I give consent to disclose and use my information for evaluation and research to
improve programs and services.
I authorize Canada Revenue Agency to release to the Ministry of Social Services any information from my income tax returns
and other taxpayer information. The information will be relevant to, and will be used solely for the purpose of determining
and verifying eligibility for, and the general administration and enforcement of the social assistance program under
The Saskatchewan Assistance Act. This authorization is valid for the taxation year prior to the year of signature and each
subsequent consecutive taxation year for which benefits are requested.
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Signature of Client Signature of Spouse (if present)
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Signature of Trustee/Receiver Witness (if signed by mark)
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Year/Month/Day