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Nce Scheme not later than the 15th day of the month following that to which payment relates. Failure to submit Schedules and remittances by the said date will incur a surcharge in keeping with the Regulations. 1. NAME OF EMPLOYER/BUSINESS: 2. ADDRESS OF BUSINESS: FOR OFFICIAL USE ONLY 5. REGISTRATION NUMBER: 3. DATE STAMP 4. CONTRIBUTION FOR THE MONTH OF: 6. EARNINGS CLASS 6.1 MONTHLY 6.2 CORRESPONDING WEEKLY Less than $1,500 TOTAL EARNINGS NUMBER OF 6.4 ACTUAL $ EMPLOYEES CONTRIBUT.

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