Ui 2 7 Form PDF Details

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QuestionAnswer
Form NameUi 2 7 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesui 2 7 form word, ui 2 7 form, ui2 7 form, ui2 7 form 2021 word download

Form Preview Example

UI-2.7

UNEMPLOYMENT INSURANCE FUND

REMUNERATION RECEIVED BY THE EMPLOYEE WHILST STILL IN

EMPLOYMENT

To: The Claims Officer

Statement in respect of payment made to the undermentioned Contributor who is still in my employment but is unable to work due to Illness, Maternity leave or the Adoption of a child.

Full names of contributor:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employers UIF Reference No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ID No of contributor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(A) In terms of section 19(1), 24(2) and 27(3) of the abovementioned Act,

 

 

 

 

 

 

 

 

I hereby certify that since (full date)

 

/

/

 

 

 

, the contributor is on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sick leave

 

 

 

 

 

 

Maternity leave

 

 

Leave due to the adoption of a child and

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

has

 

 

 

 

 

will

 

 

receive(d) the following remuneration

 

 

 

 

 

 

 

 

 

 

 

Gross remuneration

 

 

 

 

Periods during which different rates of

 

Gross remuneration

(prior to confinement)

 

 

 

 

 

 

remuneration were received

 

 

 

 

 

 

received whilst on leave

Per Month / Per Week

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(PM/PW)

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(B)The contributor is expected to return to work on __________/__________/___________.

(C)The contributor returned to work on __________/__________/___________.

DATE: ____________________

_________________________________________________

 

SIGNATURE OF EMPLOYER OR AUTHORISED AGENT

 

 

 

 

 

BUSINESS STAMP

 

 

 

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Writing part 1 in ui 2 7 form

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Step no. 2 in filling out ui 2 7 form

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