Wage Recovery Procedure - Canada Labour Code - Part III - OPD 817-1

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Appendix E.2

Acknowledgment of receipt of order to the debtor of the employer

I hereby acknowledge that I have received the order to the debtor of the employer issued by **name and proper title of the Labour Regional Head** on **date** concerning **** **name of employee** or the employees named on the attached list****, and I hereby accept service thereof this **day** day of **month**, **year**.

**Print Name**
**Signature**

**Print Name (Witness)**
**Signature**

***Att.***

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Date Modified:
2012-08-14