Marius Scheepers & Company Attorneys


mariusscheepers@irodo.com

Electronic Communications & Transactions Act Compliance:

Marius Scheepers & Company,
P.O. Box 38197,
Faerie Glen,
Pretoria,
South Africa,
0043

C/O 519 Spuy Street,
Sunnyside,
Pretoria

Telephone / Fax no.:
+27 (0)12 991 4487

Data / Fax no.:
+27 (0)82 565 5140

Mobile no.:
+27 (0)82 569 4198



Marius Scheepers and Company Attorneys and their associates accept no liability for any damages or losses suffered as a result of actions taken based on information contained herein. They are committed to regularly update all information that is subject to change from time to time. Any person may contact them for further information and to arrange for a consultation to deal with a specific issue or send an e-mail to mariusscheepers@irodo.com The information contained herein does not serve as alternative to legal advice that may be provided during a furrow assessment of the case at a proper consultation.


www.ccma.org.za
www.ccma.co.za
www.labour.org.za
www.irodo.com





 

UIF Forms

(updated 01/03)

UI-1
REGISTER TO CONFIRM CONTINUED UNEMPLOYMENT AND CONTINUED CAPACITY AND AVAILABILITY FOR WORK IN TERMS OF SECTION 17 (4) (d)

 

UI-1

UNEMPLOYMENT INSURANCE ACT 63 OF 2001
Register to confirm continued unemployment and continued capacity and availability for work in terms of section 17 (4) (d) read with regulation 3 (3)

 

 

I declare that - I have not been employed since I last signed this register, I am currently unemployed, since the last time I signed this register I have not received-

 

 

      v a monthly state pension (excluding a disability grant),

 

CONTRIBUTOR'S CHECK CARD

 

 

      v a benefit from Compensation Fund for temporary or total disablement or

PAYPOINT

 

OFFICE STAMP

 

 

      v a benefit from LRA Funds Employment Schemes and I am capable of and available for work

 

 

 

             If any of above is applicable complete following questions:

 

 

 

 

             When did you begin to receive this benefit? ____

 

TIME OF SIGNING

 

 

 

 

             Do you continue to receive this benefit?_______

 

 

 

 

             If you no longer receive this benefit when did it come to an end? ________________________

 

VENUE

 

 

 

 

I understand that it is a criminal offence to sign this register and receive benefits while employed.

 

 

 

NEXT SIGNING DATE

SIGNATURE OF CONTRIBUTOR

SIGNING OFFICIALS INITIAL

 

 

 

 

 

 

 

 

 

 

 

___________________________________
Signature of official

 

 

 

 

INFORMATION OUTSTANDING:

 

 

 

 

____________________________________________________

 

 

 

 

____________________________________________________

 

 

 

 

PERSONAL DETAILS:

 

 

 

 

Contributor's surname: _________________________________

 

 

 

 

Contributor's  first names: _______________________________

 

 

 

 

Identity no.

 

 

 

 

Specimen Signature: __________________________________

 

 

 

 

Date Indicated on the reverse side is your next signing date.

 

 

 

 

 

UI-2.1
UNEMPLOYMENT INSURANCE BENEFITS IN TERMS OF SECTION 17 (1)

 

Read with regulation 3 (1)

1.

PERSONAL DETAIL

1.1

Identity Document:

 

1.2

Passport Number

 

1.3

Other Identity/Reference Number

 

1.4

Date of Birth

 

1.5

Gender

Male

5

 

Female

0

 

 

 

 

 

 

1.6

First Names

 

1.7

Surname

 

1.8

Previous Surname

 

1.9

Postal Address

 

 

Code ...........................

1.10

Residential Address

 

 

Code ...........................

1.11

Telephone No

Code ....................................

1.12

Cell No

 

1.13

E-Mail Address

 

1.14

SARS Number

 

2.

PAYMENT DETAILS

2.1

Name of Bank or Post office

 

2.2

Branch Code

 

2.3

Account Number

 

2.4

Account Type

 

3.

METHOD OF PAYMENT: (Use the UI-2.7 form for Banking Details)

 

 

 

 

 

 

CHEQUE

 

 

CASH

 

 

BANK TRANSFER

 

 

OTHER

 

 

4.

EDUCATION BACKGROUND (tick the box)

 

SPECIAL. SCHOOL CERT.

26

˜

 

BELOW GRADE 8

 

29

˜

 

GRADE 8- 9

30

˜

 

GRADE 10 - 11

 

31

˜

 

GRADE 12

32

˜

 

TERTIARY

 

33

˜

 

5.

EMPLOYER DETAILS

5.1

NAME OF EMPLOYER/COMPANY

 

5.2

UIF REF NUMBER

 

5.3

BUSINESS ADDRESS OF EMPLOYER:

 

 

 

5.4

POSTAL ADDRESS:

 

5.5

E-MAIL

 

5.6

Telephone Number

Code ......................

5.7

Fax Number

 

6.

EMPLOYMENT DETAILS

6.1

Occupation

 

6.2

Occ. Code

 

7.

PERIOD  OF SERVICE

7.1

Commencement of employment with employer

 

7.2

Termination of Service

 

8.

REMUNERATION / SALARY

8.1

Gross pay (before deductions)

 

8.2

Salary Payment (PW or PM)

 

9.

SOURCES OF OTHER INCOME

 

During this period of unemployment have you received income from any of these sources? (Tick the box)

9.1

Monthly Pension from State (Excluding Disability grant)

˜

9.2

Benefit from Compensation Fund for temporary or total disablement

˜

9.3

Benefits from an Unemployment Fund established by bargaining or statutory council

˜

9.4

None

˜

 

When did you begin to receive this benefit? _____________________________________

 

Do you continue to receive this benefit? ________________________________________

 

If you no longer receive this benefit when did it come to an end? _____________________

 

10.

REASON FOR TERMINATION OF SERVICE

10.1

Dismissed

 

10.2

Contract Expired

 

10.3.1

Resigned

 

10.3.2

Constructive dismissal

 

10.4

Employer's insolvency

 

10.5

Other (Specify)

 

11.

FURTHER REQUIREMENTS

11.1.

Are you registered as workseeker with a Labour Centre established by the DOL

 

 

Yes ˜ No ˜

 

11.2

If so, which Labour Centre: ______________________________________

11.3

Are you capable or and available for work?

Yes ˜ No ˜

 

 

 

Signature: _______________________

 

11.4

If you are not capable or nor available for work, please explain: ____________

 

_____________________________________________________________

IMPORTANT: READ THIS SECTION BELOW:

If your application is successful then the claims officer will authorise the payment of benefits. You must report to the employment office on a regular basis as indicated by the claims officer. You must also inform the claims officer as soon as you resume employment. I declare that the above information is true and correct. I understand that it is an offence to make a false statement.

Signature of applicant: _________________________ Date: _______/ ______/ ______

 

UI-2.2
APPLICATION FOR ILLNESS BENEFITS IN TERMS OF SECTION 22 (1)

 

Read with regulations 4 (1), 4 (5) and 4 (7))

1.

PERSONAL DETAIL

1.1

Identity Document:

 

1.2

Passport Number

 

1.3

Other Identity / Reference Number

 

1.4

Date of Birth

 

1.5

Gender

 

 

Male

5

 

Female

0

 

1.6

First Names

 

1.7

Surname

 

1.8

Previous Surname

 

 

1.9

Postal Address

 

 

 

 

Code ......................

1.10

Residential Address

 

 

 

 

 

 

Code ......................

1.11

Telephone No

Code ..............................

1.12

Cell No

 

1.13

E-Mail Address

 

1.14

SARS Number

 

2.

PAYMENT DETAILS

2.1

Name of Bank or Post Office

 

2.2

Branch Code

 

2.3

Account Number

 

2.4

Account Type

 

3.

METHOD OF PAYMENT:  (Use the UI-2.7 form for Banking Details)

 

CHEQUE

 

 

CASH

 

 

BANK TRANSFER

 

 

OTHER

 

 

 

4.

EMPLOYER DETAILS

 

 

 

 

 

 

4.1

NAME OF EMPLOYER/COMPANY

 

4.2

UIF REF NUMBER

 

4.3

BUSINESS ADDRESS OF EMPLOYER:

 

 

 

4.4

POSTAL ADDRESS:

 

4.5

E-MAIL

 

4.6

Telephone Number

Code ......................

4.7

Fax Number

 

5.

EMPLOYMENT DETAILS

5.1

Occupation

 

5.2

Occ. Code

 

6.

PERIOD OF SERVICE

 

 

6.1

Commencement of employment with employer

 

6.2

Termination of Service

 

7.

REMUNERATION / SALARY

7.1

Gross pay (before deductions)

 

7.2

Salary Payment (PW or PM)

 

8.

SOURCES OF OTHER INCOME

 

During this period of unemployment have you received income from any of these sources? (Tick the box)

8.1

Monthly Pension from State (Excluding Disability grant)



8.2

Benefit from Compensation Fund for temporary or total disablement



8.3

Benefits from an Unemployment Fund established by bargaining or statutory council



8.4

None



 

When did you begin to receive this benefit? ___________________________________

 

 

Do you continue to receive this benefit? ______________________________________

 

 

If you no longer receive this benefit when did it come to an end? ___________________

 

 

1.

ARE YOU STILL EMPLOYED

YES        NO 

 

NB: IF YOU ARE STILL EMPLOYED, FORM UI-2.8 MUST BE COMPLETED.

2.

DATE OF COMMENCEMENT OF ILLNESS LEAVE: ______/______/______

3.

IF YOU HAVE RETURNED TO WORK, STATE DATE: ______/______/______

4.

 

 

 

MEDICAL CERTIFICATE (To be completed by an authorised practitioner in terms of section 20 (1) (c) of the UI Act 63 of 2001.)

 

I, __________________________________ am a qualified ____________________

 

My practice number is __________________. I confirm that _____________________ has been under my treatment from ______________ to ___________ and is suffering from ___________

 

___________________________________________________________________________

 

__________________________________ This patient was not capable of performing work from ___________________ to ____________ .

 

If the nature of the illness is described in this medical certificate in uncertain terms or as 'disease - entity' or  'symptom complex', please furnish a clinical report describing the symptoms and nature of the complaint.

 

Signature ____________________________  Date __________ Tel No. __________________

 

Address __________________________________________________

 

 

 

IMPORTANT : READ THIS SECTION BELOW:

If your application is successful then the claims officer will authorise the payment of benefits. You must inform the claims officer as soon as you resume work. I declare that the above information is true and correct. I understand that it is an offence to make a false statement.

SIGNATURE:______________________________ DATE: __________

 

UI-2.3
APPLICATION FOR MATERNITY BENEFITS IN TERMS OF SECTION 25 (1)

 

Read with regulation 5 (1) and 5 (4)

1.

PERSONAL DETAIL

1.1

Identity Document:

 

1.2

Passport Number

 

1.3

Other Identity/Reference Number

 

1.4

Date of Birth

 

1.5

Gender

Male

5

 

Female

0

 

1.6

First Names

 

1.7

Surname

 

1.8

Previous Surname

 

1.9

Postal Address

 

 

Code ......................

1.10

Residential Address

 

 

Code ......................

1.11

Telephone No

Code ..............................

1.12

Cell No

 

1.13

E-Mail Address

 

1.14

SARS Number

 

2.

PAYMENT DETAILS

2.1

Name of Bank or Post Office

 

2.2

Branch Code

 

2.3

Account Number

 

2.4

Account Type

 

3.

METHOD OF PAYMENT:  (Use the UI-284 form for Banking Details)

 

CHEQUE

 

 

CASH

 

 

BANK TRANSFER

 

 

OTHER

 

 

 

4.

EMPLOYER DETAILS

 

 

 

 

 

 

4.1

NAME OF EMPLOYER/COMPANY

 

4.2

UIF REF NUMBER

 

4.3

BUSINESS ADDRESS OF EMPLOYER:

 

 

 

4.4

POSTAL ADDRESS:

 

4.5

E-MAIL

 

4.6

Telephone Number

Code ......................

4.7

Fax Number

 

5.

EMPLOYMENT DETAILS

5.1

Occupation

 

5.2

Occ. Code

 

6.

PERIOD OF SERVICE

 

 

6.1

Commencement of employment with employer

 

6.2

Termination of Service

 

7.

REMUNERATION / SALARY

7.1

Gross pay (before deductions)

 

7.2

Salary Payment (PW or PM)

 

8.

SOURCES OF OTHER INCOME

 

During this period of unemployment have you received income from any of these sources? (Tick the box)

8.1

Monthly Pension from State (Excluding Disability grant)



8.2

Benefit from Compensation Fund for temporary or total disablement



8.3

Benefits from an Unemployment Fund established by bargaining or statutory council



8.4

None



 

When did you begin to receive this benefit? ___________________________________

 

 

Do you continue to receive this benefit? ______________________________________

 

 

If you no longer receive this benefit when did it come to an end? ___________________

 

 

1.

ARE YOU STILL EMPLOYED

YES        NO 

 

NB: IF YOU ARE STILL EMPLOYED, FORM UI-2.8 MUST BE COMPLETED.

2.

DATE OF COMMENCEMENT OF MATERNITY LEAVE: ______/______/______

3.

IF YOU HAVE RETURNED TO WORK, STATE DATE: ______/______/______

4.

 

 

MEDICAL CERTIFICATE (to be completed by a medical practitioner or registered midwife)

 

I, ______________________________________________ am a qualified ______________________________ My practice number is __________________. I confirm that____________________________ is under my treatment and is pregnant. The expected due date of birth is  _______________________

 

OR

 

I confirm that ___________________________ gave birth on ______________. \ The baby was stillborn on __________________________ \ had a miscarriage on ________________________.

 

Signature ______________________ Date __________ Tel No. ________________

 

Address ____________________________________________________________

 

 

 

IMPORTANT : READ THIS SECTION BELOW:

If your application is successful then the claims officer will authorise the payment of benefits. You must also inform the claims officer as soon as you resume employment. I declare that the above information is true and correct. I understand that it is an offence to make a false statement.

SIGNATURE OF APPLICANT: ______________________________ DATE: __________

 

UI-2.4
APPLICATION FOR ADOPTION BENEFITS IN TERMS OF SECTION 28 (1)

 

Read with regulation 6 (1)

1.

PERSONAL DETAIL

1.1

Identity Document:

 

1.2

Passport Number

 

1.3

Other Identity/Reference Number

 

1.4

Date of Birth

 

1.5

Gender

 

 

Male

5

 

Female

0

 

1.6

First Names

 

1.7

Surname

 

1.8

Previous Surname

 

 

1.9

Postal Address

 

 

 

 

Code ......................

1.10

Residential Address

 

 

 

 

 

 

Code ......................

1.11

Telephone No

Code ..............................

1.12

Cell No

 

1.13

E-Mail Address

 

1.14

SARS Number

 

2.

PAYMENT DETAILS

2.1

Name of Bank or Post Office

 

2.2

Branch Code

 

2.3

Account Number

 

2.4

Account Type

 

3.

METHOD OF PAYMENT:  (Use the UI-2.7 form for Banking Details)

 

CHEQUE

 

 

CASH

 

 

BANK TRANSFER

 

 

OTHER

 

 

 

4.

EMPLOYER DETAILS

 

 

 

 

 

 

4.1

NAME OF EMPLOYER/COMPANY

 

4.2

UIF REF NUMBER

 

4.3

BUSINESS ADDRESS OF EMPLOYER:

 

 

 

4.4

POSTAL ADDRESS:

 

4.5

E-MAIL

 

4.6

Telephone Number

Code ......................

4.7

Fax Number

 

5.

EMPLOYMENT DETAILS

5.1

Occupation

 

5.2

Occ. Code

 

6.

PERIOD OF SERVICE

 

 

6.1

Commencement of employment with employer

 

6.2

Termination of Service

 

7.

REMUNERATION / SALARY

7.1

Gross pay (before deductions)

 

7.2

Salary Payment (PW or PM)

 

8.

SOURCES OF OTHER INCOME

 

During this period of unemployment have you received income from any of these sources? (Tick the box)

8.1

Monthly Pension from State (Excluding Disability grant)



8.2

Benefit from Compensation Fund for temporary or total disablement



8.3

Benefits from an Unemployment Fund established by bargaining or statutory council



8.4

None



 

When did you begin to receive this benefit? ___________________________________

 

 

Do you continue to receive this benefit? ______________________________________

 

 

If you no longer receive this benefit when did it come to an end? ___________________

 

 

1.

ARE YOU STILL EMPLOYED

YES        NO 

 

NB: IF YOU ARE STILL EMPLOYED, FORM UI-2.8 MUST ALSO BE COMPLETED.

2.

DATE OF COMMENCEMENT OF ADOPTION LEAVE: ______/______/______

3.

IF YOU HAVE RETURNED TO WORK, STATE DATE: ______/______/______

IMPORTANT : READ THIS SECTION BELOW

If your application is successful then the claims officer will authorise the payment of benefits. You must also inform the claims officer as soon as you resume work. I declare the above information is true and correct. I understand that it is an offence to make a false statement.

SIGNATURE: ______________________________ DATE: __________

 

UI-2.5
APPLICATION FOR DEPENDANT'S BENEFITS BY SURVIVING SPOUSE OR LIFE PARTNER IN TERMS OF SECTION 31 (1)

 

Read with regulation 7 (1)

PARTICULARS OF SURVIVING SPOUSE OR LIFE PARTNER: (NOTE: In the case of a surviving spouse if there is not a marriage certificate recognised as valid in terms of any law relating to marriage in force in the Republic of South Africa, supplementary documents required by the department regarding the circumstances of the matter should be attached)

1.

PERSONAL DETAIL[S]

1.1

Identity Document:

 

1.2

Passport Number

 

1.3

Other Identity/Reference Number

 

1.4

Date of Birth

 

1.5

Date of Death

 

1.6

Gender

Male

5

 

Female

0

 

1.7

First Names

 

1.8

Surname

 

1.9

Previous Surname

 

1.10

Last Residential Address

Code ...............

 

Code .....................

1.11

Telephone No

 

1.12

Cell No

 

1.13

E-Mail Address

 

1.14

SARS Number

 

2.

EMPLOYER DETAILS

2.1

NAME OF EMPLOYER/COMPANY

 

2.2

UIF REF NUMBER

 

2.3

BUSINESS ADDRESS OF EMPLOYER:

 

 

 

2.4

POSTAL ADDRESS:

 

2.5

E-MAIL

 

2.6

Telephone Number

Code ................

2.7

Fax Number

 

 

3.

EMPLOYMENT DETAILS

3.1

Occupation

 

3.2

Occ. Code

 

4.

PERIOD OF SERVICE

4.1

Commencement of employment with employer

 

4.2

Termination of Service

 

5.

REMUNERATION / SALARY

5.1

Gross pay (before deductions)

 

5.2

Salary Payment (PW or PM)

 

6.

PERSONAL DETAILS OF SPOUSE OR LIVE [sic] PARTNER

6.1

Identity Document:

 

6.2

Passport Number

 

6.3

Other Identity/Reference Number

 

6.4

Date of Birth

 

6.5

Gender

Male

5

 

Female

0

 

6.6

First Names

 

6.7

Surname

 

6.8

Previous Surname

 

6.9

Postal Address

 

 

Code ...............

6.10

Residential Address

 

 

Code ...............

6.11

Telephone No

Code .....................

6.12

Cell No

 

6.13

E-Mail Address

 

6.14

SARS Number

 

 

7.

PAYMENT DETAILS

7.1

Name of Bank or Post Office

 

7.2

Branch Code

 

7.3

Account Number

 

7.4

Account Type

 

8.

METHOD OF PAYMENT: (Use the UI-2.7 form for Banking Details)

 

CHEQUE

 

 

BANK TRANSFER

 

 

OTHER

 

 

 

IMPORTANT : READ THIS SECTION BELOW

I declare that I am the only surviving spouse or life partner or one of  ________________ surviving spouses of the abovementioned deceased contributor, that I was not divorced from him/her and that information given in this document is true and correct. I understand that it is an offence to make a false statement.

SIGNATURE OF SURVIVING SPOUSE OR LIFE PARTNER: ____________________

DATE: _____/ _____/ _____

 

UI-2.6
APPLICATION FOR DEPENDANT'S BENEFITS BY CHILD OF DECEASED IN TERMS OF SECTION 31 (1)

 

Read with regulation 7 (1) and 7 (2)

1.

PERSONAL DETAIL[S]

1.1

Identity Document:

 

1.2

Passport Number