Overtime Claims Form

Note: Please complete all fields legibly (the processing of your claim may be delayed if the form is incomplete or illegible). Please call the following phone number should your address change after you have submitted your claim: 1-855-808-0789.
Personal Information (required for payment):
Name: / SIN: / Employee # (if known):
Birth Date:
Address:
Line 1
(street name & number)
Line 2
(Apt, Unit # etc.)
City / Province Postal Code
Contact Information
Phone # / Additional Phone # E-mail
General Information (only required if not currently an active employee):
Name of department/branch last worked: / Date last worked (approximate if not known):

Overtime Claim

NOTE: Please complete information on the following for each location and/or position with respect to which you will be making an overtime claim.

Location (name of branch) and transit (if known): / Supervisor (if known)
Position Title (for period for which you are making a claim)
Reason for Overtime (please tick multiple boxes if required)
High volumes
Customer needs
To complete paperwork
Short staffed
Special Project
Business meetings or training (outside regular business hours)
Operational Emergencies / Other
Specify other reason below:
In what way was the overtime required/permitted?
(paragraph 12 of the Claim Process document sets out further information on “permitted”)
Was this overtime previously claimed (a previous request was submitted) / Yes No
If yes to above, please provide details as to when and how was the claim made, and what was the Bank’s response?

Overtime Claim– Please provide the information below for the dates or date ranges for which you are claiming overtime. If you recall different overtime hours being worked during different periods, please use additional rows for those separate date ranges (if reasonably possible) or attach a separate sheet with additional rows/information.

Date
From / Date
To / # OT hours claimed (or best estimate if exact hours not known) / @hourly rate of pay (if known) / Total amount of claim $’s ( if known) / Comments (if any)
Supporting Documents:
List and attach any and all documents that support your claim. Please include copies of any correspondence you have exchanged with Scotiabank with respect to this overtime (if you have copies). Please note that documents are not required in order for class members to be compensated for overtime worked.

Please attach all documents and forward, by mail, fax or email[1] to: Scotiabank - Attn: Claims

HR Service Centre
888 Birchmount Rd, 7th Floor
Scarborough, Ontario, M1K 5L1
e-mail:
Fax: 416-288-6900
______
By signing and/or submitting this form, I confirm that the statements I have made above are true to the best of my knowledge and, as appropriate, are reasonable estimations of hours worked based on my recollection, and that I have not altered the copies of any documents that I have attached to this Claim.
Name (Please print first name, middle initial and last name) / Claimant Signature / Date
Important Notice: Your claim will be acknowledged within 8 business days by mail or e-mail. Should you not have received an acknowledgement by that time please contact the HR Service Centre at 1-855-808-0789.

[1] Please note that email sent over the internet and documents sent by facsimile may not be secure and the Bank does not accept liability for anything reasonably beyond its control for any loss or interception of information sent by these means.