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The undersigned acknowledges that it has been retained
by (Company),
for purposes of: (Describe)
In consideration of the foregoing, the Company agrees to pay the undersigned payment as
follows: (Describe amount)
(Describe method of payment)
It is further acknowledged that:
1. The undersigned shall be deemed an independent contractor and is not an employee,
partner, agent, or engaged in a joint venture with Company.
2. Consistent with the foregoing, the Company shall not deduct withholding taxes or any
other taxes required to be deducted by an employer as I acknowledge my responsibility to pay same as an independent
contractor.
3. I further acknowledge that I shall not be entitled to any fringe benefits,
superannuation, retirement, profit sharing or any other benefits accruing to employees.
Acknowledgement Of Independent
Contractor