Monthly Remittance Report (Form RR)

Forms / Form RR /

Regular Contributions Employee Contributions Employer Contributions Total Contributions
Pension Contributions
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Disability Contributions
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Insurance Contributions Employee Contributions Employer Contributions Total Contributions
Basic Life
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Optional Life - No. of Employees Participating:
Family Life - No. of Employees Participating:
Voluntary Accidental Death & Dismemberment (AD & D)
Employee Only Plan - No. of Employees Participating:
Family Plan - No. of Employees Participating:
Manitoba Retail Sales Tax on Insurance Contributions (Manitoba Residents ONLY)
TOTAL REGULAR CONTRIBUTIONS (A)

ADJUSTMENTS

Use this section to report PRIOR MONTH/YEAR Adjustments ONLY
You may attach written explanation for the adjustment (why it is required & applicable to what employee)
Adjustments to Group Insurance for MB residents are subject to Manitoba Retail Sales Tax (RST)

Period Pension Disability Basic Life Total
(yyyy-mm) Employee Employer Employee Employer Employee Employer
Period Optional Life Family Life Voluntary AD&D MB rst ON Total
(yyyy-mm) Employee Employee Employee INSUR CONTR
TOTAL ADJUSTMENTS (B)

Interest charged for late remittance

GRAND TOTAL (MUST MATCH DIRECT DEPOSIT OR CHEQUE AMOUNT) = (A) + (B) + (C)
Payment Instruction

Cheque - Payable to: Manitoba Municipal Employees Clearing Account. Mail this form and Cheque to: MEBP - PO Box 764, Winnipeg, MB R3C 2L4
Direct Deposit - Email this form before, or on the day of the Bank Deposit to: MEBPadmin@coughlin.ca