Establishing secure connection…Loading editor…Preparing document…

Subcontractor Statement Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

SUBCONTRACTOR’S STATEMENT
REGARDING WORKER’S COMPENSATION, PAYROLL TAX AND REMUNERATION

Version 2

New South Wales

For the purposes of this Statement a “subcontractor” is a person (or other legal entity) that has entered into a contract with a “principal contractor” to carry out work.

This Statement must be signed by a “subcontractor” (or by a person who is authorised, or held out as being authorised, to sign the statement by the subcontractor) referred to in any of s175B Workers Compensation Act 1987, Schedule 2 Part 5 Payroll Tax Act 2007, and s127 Industrial Relations Act 1996 where the “subcontractor” has employed or engaged workers or subcontractors during the period of the contract to which the form applies under the relevant Act(s). The signed Statement is to be submitted to the relevant principal contractor.

SUBCONTRACTOR’S STATEMENT

(Refer to the back of this form for Notes, period of Statement retention, and Offences under various Acts.)

Subcontractor: ABN:

of

has entered into a contract with ABN:

Contract number/identifier

This Statement applies for work between: and inclusive,

subject of the payment claim dated:

I, a Director or a person authorised by the Subcontractor on whose behalf this declaration is made, hereby declare that I am in a position to know the truth of the matters which are contained in this Subcontractor’s Statement and declare the following to the best of my knowledge and belief:

(a) The abovementioned Subcontractor has either employed or engaged workers or subcontractors during the above period of this contract. Tick if true and comply with (b) to (g) below, as applicable. If it is not the case that workers or subcontractors are involved or you are an exempt employer for workers compensation purposes tick and only complete (f) and (g) below. You must tick one box.

(b) All workers compensation insurance premiums payable by the Subcontractor in respect of the work done under the contract have been paid. The Certificate of Currency for that insurance is attached and is dated

(c) All remuneration payable to relevant employees for work under the contract for the above period has been paid.

(d) Where the Subcontractor is required to be registered as an employer under the Payroll Tax Act 2007, the Subcontractor has paid all payroll tax due in respect of employees who performed work under the contract, as required at the date of this Subcontractor’s Statement.

(e) Where the Subcontractor is also a principal contractor in connection with the work, the Subcontractor has in its capacity of principal contractor been given a written Subcontractor’s Statement by its subcontractor(s) in connection with that work for the period stated above.

(f) Signature

Full name

(g) Position/Title

Date

NOTE: Where required above, this Statement must be accompanied by the relevant Certificate of Currency to comply with section 175B of the Workers Compensation Act 1987.

Notes

1. This form is prepared for the purpose of section 175B of the Workers Compensation Act 1987, Schedule 2 Part 5 Payroll Tax Act 2007 and section 127 of the Industrial Relation Act 1996. If this form is completed in accordance with these provisions, a principal contractor is relieved of liability for workers compensation premiums, payroll tax and remuneration payable by the subcontractor.

A principal contractor can be generally defined to include any person who has entered into a contract for the carrying out of work by another person (or other legal entity called the subcontractor) and where employees of the subcontractor are engaged in carrying out the work which is in connection with the principal contractor’s business.

2. For the purpose of this Subcontractor’s Statement, a principal contractor is a person (or other legal entity), who has entered into a contract with another person (or other legal entity) referred to as the subcontractor, and employees/workers of that subcontractor will perform the work under contract. The work must be connected to the business undertaking of the principal contractor.

3. Provide the unique contract number, title, or other information that identifies the contract.

4. In order to meet the requirements of s127 Industrial Relations Act 1996, a statement in relation to remuneration must state the period to which the statement relates. For sequential Statements ensure that the dates provide continuous coverage.

Section 127(6) of the Industrial Relations Act 1996 defines remuneration ‘as remuneration or other amounts payable to relevant employees by legislation, or under an industrial instrument, in connection with work done by the employees.’

Section 127(11) of the Industrial Relations Act 1996 states ‘to avoid doubt, this section extends to a principal contractor who is the owner or occupier of a building for the carrying out of work in connection with the building so long as the building is owned or occupied by the principal contractor in connection with a business undertaking of the principal contractor.’

5. Provide the date of the most recent payment claim.

6. For Workers Compensation purposes an exempt employer is an employer who pays less than $7500 annually, who does not employ an apprentice or trainee and is not a member of a group.

7. In completing the Subcontractor’s Statement, a subcontractor declares that workers compensation insurance premiums payable up to and including the date(s) on the Statement have been paid, and all premiums owing during the term of the contract will be paid.

8. In completing the Subcontractor’s Statement, a subcontractor declares that all remuneration payable to relevant employees for work under the contract has been paid.

9. In completing the Subcontractor’s Statement, a subcontractor declares that all payroll tax payable relating to the work undertaken has been paid.

10. It is important to note that a business could be both a subcontractor and a principal contractor, if a business ‘in turn’ engages subcontractors to carry out the work. If your business engages a subcontractor you are to also obtain Subcontractor’s Statements from your subcontractors.

Statement Retention

The principal contractor receiving a Subcontractor’s Statement must keep a copy of the Statement for the periods stated in the respective legislation. This is currently up to seven years.

Offences in respect of a false Statement

In terms of s127(8) of the Industrial Relations Act 1996, a person who gives the principal contractor a written statement knowing it to be false is guilty of an offence if:

(a) the person is the subcontractor;

(b) the person is authorised by the subcontractor to give the statement on behalf of the subcontractor; or

(c) the person holds out or represents that the person is authorised by the subcontractor to give the statement on behalf of the subcontractor.

In terms of s175B of the Workers Compensation Act and clause 18 of Schedule 2 of the Payroll Tax Act 2007 a person who gives the principal contractor a written statement knowing it to be false is guilty of an offence.

Further Information

For more information, visit the WorkCover website www.workcover.nsw.gov.au, Office of State Revenue website www.osr.nsw.gov.au, or Office of Industrial Relations, Department of Commerce website www.commerce.nsw.gov.au. Copies of the Workers Compensation Act 1987, the Payroll Tax Act 2007 and the Industrial Relations Act 1996 can be found at www.legislation.nsw.gov.au.

Enter text✕

What the Subcontractor Statement Form is and its role in contracting

A Subcontractor Statement Form is a written declaration used by subcontractors to confirm work performed, amounts invoiced, and any subcontracting tiers or lien waivers tied to a construction or services project. It documents payment claims, scope summaries, and certifications about payroll, taxes, or lien releases when required. Project owners, general contractors, and payers use it to validate invoiced work before disbursement, support 1099 reporting, and reduce disputes. The form is commonly paired with invoices, lien waivers, and W-9 or contractor registration details to create a complete payment package.

Why a clear Subcontractor Statement Form matters for payments and compliance

A well-prepared Subcontractor Statement Form reduces payment delays, clarifies scope and amounts, and creates an audit-ready record for tax and lien purposes. It supports 1099 reporting and backup withholding obligations under IRS rules, helps contractors manage lien exposure, and documents the chain of subcontracting for owner or lender review.

Why a clear Subcontractor Statement Form matters for payments and compliance

Who typically completes and relies on this form

Common users include subcontractors, general contractors, owners, and accounts payable teams; each has a different need for accuracy and proof.

  • Subcontractors preparing claims, invoices, and certifications for payment approval and tax reporting.
  • General contractors collecting verified statements to assemble pay applications and to manage lien exposure.
  • Owners and lenders using statements to confirm work progress and release retainage or payments.

Tailor the form fields and attachments to the party receiving it to avoid rework and ensure timely payment.

Primary signers and their responsibilities

General Contractor — Project Manager

The project manager verifies subcontractor statements against field reports and contracts, authorizes payment holds or releases, and retains copies for project accounting and lien defense. They typically request supporting attachments such as lien waivers and W-9s.

Subcontractor — Owner/Principal

The subcontractor certifies work performed and amounts billed, confirms payroll and tax compliance when required, and signs to attest truthfulness. Errors or mismatched names can trigger backup withholding or rejection of payment.

Essential sections to include in a professional Subcontractor Statement Form

A complete form balances clarity for payers with legal safeguards for both parties. Include identification, scope, monetary detail, and certification language tailored to the project and jurisdiction.

Contractor Identity

Full legal business name, DBAs, and EIN or TIN. Consistent naming avoids TIN mismatches and backup withholding triggers.

Work Description

Concise description of tasks, location, and dates of performance so claims match progress reports and site logs.

Amounts & Payment

Line items for gross amount, previous payments, retainage, and net due. Specify currency and payment terms.

Lien / Waiver Language

Optional conditional waiver or release clauses tied to payment amount; specify full or partial release and effective date.

Attachments

List required documents: invoices, W-9, lien waivers, certified payroll, or insurance certificates.

Certification

Signature block with printed name, title, date, and a statement attesting accuracy and authority to sign.

Step-by-step: completing and submitting the form

Follow these steps to prepare a professional statement that supports prompt payment and reduces administrative friction.

  • 01
    Gather documents: Collect invoice, W-9, and lien waiver.
  • 02
    Complete fields: Enter names, dates, and amounts accurately.
  • 03
    Attach proof: Upload supporting invoices and certifications.
  • 04
    Sign and send: Sign electronically or physically and submit to payer.

How to configure a simple digital workflow for this form

Map form fields and routing once, then reuse as a template for each project to streamline approvals and recordkeeping.

Field Configuration
Name & TIN Required text fields, validate format via regex
Amounts Numeric fields with currency format
Attachments Required file upload type PDF/JPEG
Signer Order Subcontractor then GC then Owner

Typical electronic routing for approvals and record capture

A streamlined eSubmission collects signatures, timestamps, and audit data while routing documents to stakeholders in order.

  • Prepare: Uploader configures fields and attachments.
  • Route: Send to signers in defined order.
  • Sign: Each signer authenticates and signs.
  • Archive: System stores signed PDF and audit trail.

Technical considerations for digital completion and eSubmission

Choose a platform that supports the file formats and integrations you need to route and store signed statements securely.

  • File formats: PDF and DOCX supported
  • Integrations: Connects with NetSuite, Google Workspace
  • Authentication: Email, SMS, or advanced options

Security and compliance features to verify

In transit: TLS 1.2/1.3
At rest: AES-256 encryption
Audit trail: Timestamps, IP, action log
HIPAA: BAA available
ESIGN / UETA: Legal validity adherence
Access controls: SSO and role permissions

Common mistakes that delay payment and how to avoid them

  • Missing or inconsistent legal names between the statement and W-9 often trigger payer review and delay payment by days or weeks.
  • Incorrect or absent TIN/EIN entries can lead to backup withholding at the IRS rate of 24% and a denied payment.
  • Failing to attach required lien waivers or invoices forces manual follow-up and adds administrative steps for approval.
  • Unsigned statements, or initials used where a full signature is required, typically cause the payer to return the package for correction.

Key risks and legal consequences of errors

Backup Withholding: 24% withholding on payments when TIN invalid
1099 Penalties: IRC §6721 penalties apply for late/incorrect filings
I-9 Violations: Documentation failures can trigger fines
Lien Exposure: Incorrect waivers may not release lien rights
Contract Disputes: Vague scope invites payment withholding
Recordkeeping: Insufficient records increase audit risk

Deadlines and timing considerations tied to payment and reporting

Observe payer schedules, tax reporting dates, and any contractually defined submission windows to avoid penalties or withheld funds.

W-9 Provision:

No IRS filing deadline; provide upon payer request

1099-NEC Reporting:

Recipient and IRS due Jan 31 each year

Payment Certification:

Submit per contract-specific progressive pay schedule

Retain Copies:

Keep signed records to support year-end filings

Backup Withholding Trigger:

Immediate effect when TIN mismatches are discovered

Key milestones from submission to archived record

Track these stages so stakeholders know when to expect approvals, corrections, and final archive of the signed statement.

01

Submission

Subcontractor submits form and attachments

02

Verification

GC or owner confirms scope and amounts

03

Approval

Authorized signer approves payment

04

Archive

Signed PDF and audit trail stored

eSignature vendor comparison for completing the Subcontractor Statement Form

Basic capability differences and starting prices for common eSignature providers; signNow is listed first per platform comparison conventions.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes (Business Premium) Varies Varies Varies Varies
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA available) Varies Varies Varies Varies

Practical examples of when and how the form is used

Two concise scenarios illustrate common uses and document pairings that reduce payment friction.

Project Draw Submission

A subcontractor completes the statement with line-item costs and attaches invoices

  • The GC matches it to progress photos and the draw request
  • The packaged statement, invoice, and conditional waiver support a lender draw and speed payment remittance when validated.

Final Payment and Lien Release

At project close the subcontractor submits a final statement and full lien waiver

  • The owner verifies final quantities and clearances
  • Executed statements and waivers are archived to prevent future lien claims and to support 1099 reporting.

Practical tips to speed approval and reduce disputes

Use consistent naming, attach required documents, and choose an eSignature flow that captures evidence of signing and delivery.

Standardize templates
Create a template with mandatory fields and attachment checks to prevent missing information.
Verify TINs
Confirm EIN/TIN on the W-9 to avoid backup withholding and filing errors.
Use clear waiver language
Make waiver conditions explicit and tie releases to specific payment amounts and dates.
Preserve audit trails
Capture timestamps, IP, and signer authentication to support dispute resolution and compliance.

Frequently asked questions about Subcontractor Statement Forms

Answers to common procedural and legal questions encountered when completing or accepting subcontractor statements.


Need help? Contact support

be ready to get more
Join over 28 million airSlate SignNow users