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Employers please remember to change year to 2021 when uploading December’s earnings.
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Unemployment Declaration
Unemployment Declaration
Step
1
of
2
50%
Name
First
Middle
Last
Address
District
Parish
St. Lucy
St. Peter
St. Andrew
St. James
St. Joseph
St. George
St. Thomas
St. John
St. Michael
St. Philip
Christ Church
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
St. Lucy
St. Peter
St. Andrew
St. James
St. Joseph
St. George
St. Thomas
St. John
St. Michael
St. Philip
Christ Church
Zip/Postal Code
Signature
*
Consent
*
Click here to indicate that you have read and agreed to the declaration above.
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