Employee Gratuity (Tips) Tax Declaration Form
Employee Gratuity (Tips) Tax Declaration Form – Please complete all fields to declare gratuity or tips received during your pay period.
Employee Full Name
*
First Name
Last Name
Employee ID
*
Job Title
*
Department
*
Pay Period Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pay Period End Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Total Gratuity/Tips Received (in USD)
*
Primary Method(s) of Receiving Tips
*
Cash
Electronic (e.g. POS, app)
Other
Brief Description or Comments (optional)
Signature – Please sign to confirm the accuracy of this declaration
*
Submit Declaration
Submit Declaration
Should be Empty: