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About Us
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COVID-19 Procedures

Unemployment Declaration

Unemployment Declaration

Name
First Middle Last
Address
District
Parish
Zip/Postal Code
National Insurance Number*
National Registration Number*
Email
Date of Original Claim*
DD slash MM slash YYYY
I have not worked or received any remuneration since the date of the original unemployment claim.
- Agree
- Disagree
I am able and willing to do suitable work but I was unable to find any.
- Agree
- Disagree
I have not been out of the Island since the date of the Claim.
- Agree
- Disagree
I acknowledge that if I make any false statement or give false information for the purpose of obtaining the benefit, I may be prosecuted and liable on conviction to a fine of one thousand dollars ($1000.00) or imprisonment for six months or both.
- Agree
- Disagree
I acknowledge that if I fail to submit a claim by the due date provided by the National Insurance Office that I may lose the benefit.
- Agree
- Disagree
If out of the Island during the claim for unemployment, please indicate the period that you have been out of the Island.
DD slash MM slash YYYY

From:
To:
MM slash DD slash YYYY
Name of Employer
Date of Re-employment
DD slash MM slash YYYY
Address
District
Parish
Zip/Postal Code
Signature*
Consent*
Click here to indicate that you have read and agreed to the declaration above.

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