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Unemployment Insurance Act Regulations, 1966 Published under Government Notice (GN) R849 in Government Gazette (GG) 8683 of 29 April 1983 as amended by GN R1235 in GG 8760 of 17 June 1983 Schedule 1 Definitions In these Regulations, unless the context otherwise indicates- ‘Act’ means the Unemployment Insurance Act, 1966 (Act 30 of 1966); and any word or expression to which a meaning has been assigned in the Act, shall bear the meaning so assigned to it; ‘annexure’ means an annexure to these Regulations; ‘Director-General’ means the Director-General: Labour; ‘identity document’ means an identity document referred to in section 8 of Act 72 of 1986 and includes an identity certificate referred to in section 9 of the said Act; ‘identity number’ means an identity number referred to in section 5 (2) of Act 72 of 1986; ‘Provincial Director’ means- (a) in the Province of KwaZulu-Natal, the Provincial
Director, Department of Labour, P.O. Box 940, Durban, 4000; (b) in the Province of the Northern Cape, the Provincial
Director, Department of Labour, Private Bag X5012, Kimberley, 8300; (c) in the Northern Province, the Provincial Director, Department
of Labour, Private Bag X9368, Pietersburg, 0700; (d) in the Province of the North West, the Provincial
Director, Department of Labour, Private Bag X2040, Mmabatho, 8681; (e) in the Province of the Eastern Cape, the Provincial
Director, Department of Labour, Private Bag X9005, East London, 5200; (f) in the Province of Mpumalanga, the Provincial Director,
Department of Labour, Private Bag X7263, Witbank, 1035; (g) in the Province of the Free State, the Provincial
Director, Department of Labour, P.O. Box 522, Bloemfontein, 9300; (h) in the Province of Gauteng: (i) Gauteng
South, in the Magisterial Districts of Alberton, Boksburg, Brakpan,
Germiston, Heidelberg, Johannesburg, Kempton Park, Oberholzer, Randburg,
Roodepoort, Vanderbijlpark, Vereeniging and Westonaria, the Provincial
Director, Department of Labour, P.O. Box 4560, Johannesburg, 2000; (ii) Gauteng
North, in the Magisterial Districts of Benoni, Bronkhorstspruit, Cullinan,
Krugersdorp, Nigel, Pretoria, Randfontein, Soshanguve 1, Soshanguve 2,
Springs and Wonderboom, the Provincial Director, Department of Labour, P.O.
Box 393, Pretoria, 0001; and (i) in the Province of the Western Cape, the Provincial Director,
Department of Labour, P.O. Box 872, Cape Town, 8000. [Definition of ‘Provincial Director’ inserted by GN R1068 of 28 June 1996.] ‘reference book’ means a reference book referred to in section 3 (1) (b) (i) of the Blacks (Abolition of Passes and Co-ordination of Documents) Act, 1952 (Act 67 of 1952), and includes an identity document referred to in section 3 (1) (b) (ii) of the said Act, a document referred to in section 3 (2) of the said Act, a duplicate of such book or document and, in respect of foreign Blacks, also a passport and worker’s travel documents; and ‘reference book number’ means the number allocated to or the serial number of a reference book. ‘Regional Director’ …… [Definition of ‘Regional Director’ amended by GN R272 of 24 February 1989 and by GN R2962 of 21 December 1990 and deleted by GN R1068 of 28 June 1996.] [Regulation 1 substituted by GN R2115 of 21 October 1988.] 2 Production of Identity Documents or Reference Books A claims officer, duly authorised officer or other State employee or an agent may require an applicant for benefits or allowances or for the payment of an amount in terms of the Act to produce his identity document or reference book for inspection, but may not retain such document or book. 3 Appeals in Terms of Sections 21 and 27 of the Act (1) (a) An appeal to a committee in terms of section 27 (1) of the Act shall contain the following information: (i) Name and
address of appellant; (ii) identity
number or reference book number; (iii) name and
address of last employer; (iv) date of
application for benefits; (v) office at
which application made; (vi) date of
notification of decision of claims officer; (vii) particulars
of decision appealed against; (viii) grounds
on which appeal is based. (b) A committee may require the appellant to furnish such further information as it may deem necessary to enable it to deal with the appeal. (c) The committee shall notify its decision on the appeal, in writing, to the appellant and to the claims officer. (2) (a) An appeal to the board in terms of section 21 (1) of the Act shall be in duplicate and shall contain information on the following points: (i) Name and
address of appellant; (ii) identity
number or reference book number; (iii) name and
address of last employer; (iv) date of
application for benefits; (v) office at
which application made; (vi) date of
notification of decision of committee; (vii) particulars
of decision appealed against; (viii) grounds
on which appeal is based. (b) The board may require the appellant to furnish such further information as it may deem necessary to enable it to deal with the appeal. (c) The board shall notify its decision on the appeal, in writing, to the appellant and to the committee concerned. 4 Allowances Payable to Members of Board and Committees (1) A member of the board or of a committee, other than a member who is an officer, shall be paid a remuneration or allowance of, in the case of a board member, R60,00 per hour with a maximum of R477,00 per day and, in the case of a committee member, R50,00 per hour with a maximum of R398,00 per day, in respect of every hour during which such member attends or travels to or from a meeting of the board or of a committee, as the case may be. [Subregulation (1) amended by GN R1235 of 17 June 1983 and substituted by GN R901 of 16 May 1986, by GN R1114 of 6 June 1986, by GN R2161 of 2 October 1987, by GN R1707 of 27 July 1990, by GN R2585 of 11 September 1992, by GN R2936 of 23 October 1992, by GN R1447 of 13 August 1993, by GN R1701 of 3 November 1995, by GN R297 of 23 February 1996, by GN R249 of 14 February 1997 and by GN R1498 of 27 November 1998.] (2) A member of the board or of a committee, other than an officer or other State employee, who is required to travel on the business of the board or of a committee shall- (a) if the journey or any portion thereof can be performed by
using the transport service of Transnet Ltd. or of the South African Rail
Commuter Corporation Ltd. be paid the amount of a first class return fare for
such journey or part thereof; [Para. (a) amended by GN R2585 of 11 September 1992.] (b) if the journey or any part thereof cannot be performed by
using any of the services referred to in paragraph (a) or if it is
impracticable in the circumstances to make use thereof, be reimbursed the
cost of travelling by any other public transport service: Provided that if a
member wishes to travel by air or shipping service, he shall obtain the prior
approval of the Director-General; (c) if the journey or any part thereof cannot be performed by
using any of the means of transport referred to in paragraph (a) or (b),
or if is impracticable in the circumstances to make use thereof, be paid an
allowance towards the cost of any other transport, including his own, at the
rate prescribed from time to time for the use of private transport for
official purposes by officers of the Public Service. (3) In addition to the allowances prescribed in subregulation (1), a member of the board or of a committee who has been appointed by the Minister to represent the interests of contributors and who loses wages as a result of attending any board, committee or subcommittee meeting which he is required to attend, shall be reimbursed the amount of such wages lost. [Subregulation (3) amended by GN R1235 of 17 June 1983.] (4) For the purposes of this regulation ‘member’ includes an alternate who attends a meeting and acts in the stead of a member who is absent. 5 Registration of Employers (1) Every employer who is required to furnish the Director-General with prescribed particulars in terms of section 28 (1) of the Act shall furnish the particulars specified in Annexure UF 1. (2) The said particulars shall be forwarded by every such employer to the Unemployment Insurance Fund, Laboria Buildings, Paul Kruger Street, (P.O. Box 1851), Pretoria, 0001. 6 Notification in Terms of Section 28 of the Act (4) of Particulars of Contributors (1) Every employer shall, within one month of taking into his employment a contributor who is not in possession of a contributor’s record card or who is unable to produce such card, whether or not such contributor was previously provided with such card, furnish the Director-General with the particulars specified in Annexure UF 85, in respect of each such contributor. (2) Such particulars shall be furnished by forwarding Annexure UF 85, duly completed, to the Employment Insurance Fund, Laboria Buildings, Paul Kruger Street, (P.O. Box 1851), Pretoria, 0001. 6A Application to be exempted from liability to contribute to the Unemployment Insurance Fund An application to be exempted from liability to contribute to the Unemployment Insurance Fund in terms of section 2 (5) (a) (i) of the Act shall be in the form of and contain the information called for in Annexure UF 64. [Regulation 6A inserted by GN R643 of 16 April 1993.] 7 Payment of Contributions (1) The amount of the contributions which an employer is required to pay the Director-General in terms of section 29 (3) of the Act shall be forwarded by such employer to the Unemployment Insurance Fund, Laboria Buildings, Paul Kruger Street, (P.O. Box 1851), Pretoria, 0001. (2) When an employer pays any contributions to the Unemployment Insurance Fund in terms of section 29 (3) of the Act, such contributions shall be accompanied by a statement in the form of Annexure UF 3 which shall contain the particulars specified therein and shall be certified by him as true and correct. [Subregulation (2) substituted by GN R643 of 16 April 1993.] (3) Any person who has been an employer and who receives from the Fund a form UF 3 in respect of any month in which he has not employed any contributor, shall return such form, duly signed, to the Fund with an endorsement to that effect and stating the date upon which a contributor was last employed by him. 8 Contributors’ Record Cards (1) The record card which the Director-General is required to issue in terms of section 33 (1) of the Act shall be in the form of Annexure UF 74, and shall be forwarded to the employer of the contributor concerned on receipt of the prescribed particulars referred to in regulation 6. (2) Every employer shall keep, in respect of every contributor employed by him, a record showing- (a) the name of such contributor; (b) the date upon which such contributor commenced employment
with him as a contributor; (c) the date upon which his employment as a contributor
terminated; (d) the weekly or monthly rate of earnings of such
contributor during the 13 weeks immediately preceding the date of termination
of such employment; (e) the date upon which the employer received the
contributor’s record card (UF 74) of such contributor from the said
contributor, or from the Director-General, as the case may be; (f) the date upon which the employer disposed of such
contributor’s record card; (g) the manner of such disposal. (3) The Director-General may, on receipt of an application in the form of Annexure UF 107 and upon payment of a fee of 50c, issue a contributor’s record card in substitution for any such record card which he is satisfied has been lost or destroyed and he may also, on receipt of an application in the form of Annexure UF 107 and upon payment of such amount, issue a contributor’s record card in respect of any person, including a deceased person, on submission of satisfactory proof that such person was a contributor at any time since 1 January 1950: Provided that the Director-General may, at his discretion, issue a record card, free of charge, if he is satisfied that the circumstances warrant such free issue. 9 Statement to Accompany Contributor’s Record Card An employer who is required in terms of section 33 (3) of the Act to forward a contributor’s record card to a claims officer shall forward with such card a statement in the form of and containing the particulars specified in Annexure UF 125. 10 Payment of Unemployment benefits in Terms of Section 35 of the Act (1) An application for benefits in terms of section 35 of the Act shall be presented by the applicant personally at an office of the Department of Manpower, a magistrate, a commissioner, a labour bureau or an agent, as the case may be, for transmission to the claims officer having jurisdiction and shall be in the form of and contain the particulars specified in Annexure UF 123. (2) Whenever a contributor has applied for benefits he shall, when making such application or as soon as possible thereafter, hand his contributor’s record card to the claims officer having jurisdiction in the area in which such contributor resides, or to a duly authorised officer or other State employee, or to an agent, as the case may be. (3) A claims officer or duly authorised officer or other State employee or an agent may retain a contributor’s record card, which has been handed to him in terms of subregulation (2) if he deems it expedient to do so, and shall in such event furnish the contributor with a contributor’s check card in the form of Annexure UF 7. (4) The claims officer, duly authorised officer, other State employee or an agent who has retained the contributor’s record card of a contributor, shall return to such contributor the contributor’s record card in exchange for the check card, if he is satisfied that such contributor has obtained employment, or if he no longer requires the said contributor’s record card. (5) An applicant for employment benefits shall, at such times and places as the claims officer may determine, sign an unemployment register in the form of and containing the particulars specified in Annexure UF 103 or UF 103A. (6) Notwithstanding the provisions of subregulation (5), a claims officer may, in individual cases, accept other evidence satisfactory to him that a contributor is unemployed and is capable of and available for work. (7) (a) An application for the payment of further benefits to a contributor in terms of section 35 (14) of the Act shall be in the form of and contain the particulars specified in Annexure UF 139. (b) Such application shall be submitted in duplicate to the claims officer having jurisdiction in the area in which the applicant resides. (8) …… [Subregulation (8) deleted by GN R960 of 20 May 1988.] 11 Payment of Illness Benefits in Terms of Section 36 of the Act (1) An application for illness benefits in terms of section 36 of the Act shall be made by the person entitled thereto, or by a person authorised by the claims officer in terms of section 36 (3) (b) of the Act to make such application and shall be in the form of and contain the particulars specified in Annexure UF 86. Such application shall be presented at or forwarded to an office of the Department of Manpower, a magistrate, commissioner, labour bureau or an agent, as the case may be, for transmission to the claims officer having jurisdiction in the area in which the applicant resides or resides temporarily and shall be accompanied by the contributor’s record card of the applicant, unless such applicant is not in possession of such card, in which case the said card shall be submitted to the claims officer as soon as possible thereafter. (2) A contributor whose application for illness benefits has been approved by a claims officer may be paid such benefits by cheque in respect of any period approved by the claims officer in terms of the Act. (3) Payments for subsequent periods, may, subject to the provisions of section 34 (5) of the Act, be approved by the claims officer on receipt of the details and declaration specified in, and in the form of Annexure UF 87. Such form shall be signed by the contributor in the space provided for the purpose: Provided that, if the claims officer is satisfied that such contributor is unable to sign such form, he may accept the signature of such person as he may deem fit to sign on behalf of such contributor. (4) (a) The medical certificates on Annexures UF 86, UF 87 and UF 140, shall be completed and signed by the medical practitioner, chiropractor or homeopath by whom the applicant has been treated: provided that a claims officer may require an applicant to be examined by a medical officer, medical practitioner, chiropractor or homeopath nominated by the claims officer. (b) The costs of a medical examination required by a claims officer under paragraph (a) shall be charged against the Unemployment Insurance Fund. [Subregulation (4) substituted by GN R960 of 20 May 1988.] (5) If the nature of the illness can be described in the medical certificate forming part of Annexure UF 86, UF 87 or UF 140 in uncertain terms or as ‘disease-entity’ or ‘symptom-complex’, the contributor shall furnish a clinical report from the medical practitioner, chiropractor or homeopath describing the symptoms and nature of the complaint from which such contributor is suffering. [Subregulation (5) substituted by GN R960 of 20 May 1988.] (6) (a) An application for the payment of further benefits to a contributor in terms of section 36 (9) of the Act shall be in the form of the contain the particulars specified in Annexure UF 140. (b) Such application shall be submitted in duplicate to the claims officer having jurisdiction in the area in which the applicant resides. 12 Payment of Maternity Benefits in Terms of Section 37 of the Act (1) An application for maternity benefits in terms of section 37 of the Act shall be made by the person entitled thereto and shall be in the form of and contain the particulars specified in Annexure UF 92. Such application shall be presented at or forwarded to an office of the Department of Manpower, a magistrate, commissioner, labour bureau or an agent, as the case may be, for transmission to the claims officer having jurisdiction in the area in which the contributor resides or resides temporarily and shall be accompanied by the contributor’s record card of the applicant unless such applicant is not in possession of such card, in which case the said card shall be submitted to the claims officer as soon as possible thereafter. (2) A contributor who has applied for benefits in terms of section 37 shall submit to the claims officer a declaration in the form of Annexure UF 93 covering each period up to and including the date of birth of the child in respect of which pre-natal maternity benefits are claimed. (3) The contributor shall, as soon as possible after the birth of the child, submit to the claims officer in the form of Annexure UF 94 a declaration made by her and a notification of birth by a medical practitioner or a midwife and, if required by the claims officer a further declaration in the form of Annexure UF 95, covering each period subsequent to the date of birth of the child, in respect of which post-natal maternity benefits are claimed or any period up to and including the date of birth of the child in respect of which a declaration in the form of Annexure UF 93 has not been made. (4) A contributor who applies for benefits in terms of section 37 after her child has been born shall lodge a form UF 92, duly completed except for the medical certificate appearing therein, with the claims officer together with a declaration and notification of birth in the form of Annexure UF 94 completed by her and a medical practitioner or a midwife, and if required by the claims officer at any time, a declaration in the form of Annexure UF 95. (5) The claims officer may, if he deems it expedient, require the applicant to produce the birth certificate of the child in respect of whose birth the application has been made, or he may accept such birth certificate together with a declaration in the form of Annexure UF 95 in lieu of a completed Annexure UF 94. (6) The medical certificate on Annexure UF 92 shall, except where not required in terms of subregulation (4), be completed and signed by the medical practitioner by whom the applicant has been examined: Provided that a claims officer may require an applicant to be examined by a medical officer or practitioner nominated by him. The fee for a medical examination conducted at the instance of a claims officer shall be a charge upon the Unemployment Insurance Fund. (7) A contributor whose application for benefits in terms of section 37 of the Act has been approved may be paid such benefits by cheque in respect of any period approved by the claims officer. 12A Payment of Adoption Benefits in Terms of Section 37A of the Act (1)(a) An application for adoption benefits in terms of section 37A of the Act shall- (i) be made by
the person claiming such benefits; (ii) be in the
form of and contain the particulars specified in Annexure UF 92A; (iii) be
presented at, or forwarded to an office of the Department of Manpower, a
magistrate or an agent, as the case may be, for transmission to the claims
officer having jurisdiction in the area in which the contributor resides or
resides temporarily; and (iv) be
accompanied by- (aa) the contributor’s record card (UF 74) of the applicant
unless the applicant is not in possession of such card, in which case the
said card shall be submitted to the claims officer as soon as possible
thereafter; (bb) a
certified copy of the birth certificate of the child concerned and of the
application to a children’s court in terms of section 18 (2) of the Child
Care Act, 1983 (Act 74 of 1983), for the adoption of that child; and (cc) if an
adoption order has already been issued by the children’s court, a certified
copy of that order. (b) If the children’s court has not already issued such an order on the date of application for adoption benefits, a certified copy of the order shall be submitted to the claims officer, as soon as possible after it has been issued. (c) If the date of the application to a children’s court in terms of section 18 (2) of the Child Care Act, 1983, does not appear on the adoption order, documentary proof of that date shall be submitted. [Subregulation (1) substituted by GN R643 of 16 April 1993.] (2) A contributor who has applied for benefits in terms of section 37A of the Act shall submit to the claims officer a declaration in the form of Annexure UF 93 (A) in respect of each further period of unemployment until adoption benefits have been paid to the contributor for a period of twenty-six weeks. (3) A contributor whose application for benefits in terms of section 37A of the Act has been approved may be paid such benefits by cheque in respect of any period approved by the claims officer. [Regulation 12A inserted by GN R2412 of 30 October 1987.] 13 Payments to Dependants of Deceased Contributors in Terms of Section 38 of the Act (1) An application for a payment in terms of section 38 of the Act shall, where the applicant is a widow or an invalid widower, be in the form of and contain the information called for in Annexure UF 126 and where the applicant is a person other than a widow or widower, be in the form of an contain the information called for in Annexure UF 127. [Subregulation (1) amended by GN R1235 of 17 June 1983 and substituted by GN R2412 of 30 October 1987.] (2) An application referred to in subregulation (1) shall be accompanied by- (a) the contributor’s record card of the deceased
contributor; (b) the death certificate relating to the death of such
contributor: Provided that the Director-General may accept a post-mortem
certificate or a burial order in lieu of a death certificate; (c) a certificate from the last employer of the deceased
contributor in the form of and containing the information called for in
Annexure UF 128; and (d) where the application is made by a widow or a widower,
the marriage certificate of the deceased contributor: Provided that in the
case of a widow or a widower who was a participant in a customary union
according to indigenous law and custom, where neither the man nor the woman
was a party to a subsisting marriage, the Director-General may accept such
evidence as he may deem fit of the existence of such customary union. [Para. (d) amended by GN R1235 of 17 June 1983 and by GN R2412 of 30 October 1987 and substituted by GN R1884 of 9 August 1991.] (3) An employer who employed a deceased contributor, shall, at the request of the Director-General, a regional director or an applicant for payment in terms of section 38 of the Act forward forthwith to the Director-General, such regional director or such applicant, as the case may be, the contributor’s record card of such deceased contributor, together with a certificate in the form of Annexure UF 128 containing the information called for therein in regard to such deceased contributor. [Subregulation (3) amended by GN R1884 of 9 August 1991.] (4) The Director-General, a regional director or the board may require an applicant or any person who was the employer of a deceased contributor to furnish such other information as the Director-General, such regional director or the board, as the case may be, may deem necessary to enable proper consideration to be given to an application for a payment in terms of section 38 of the Act. [Subregulation (4) amended by GN R1884 of 9 August 1991.] 14 Payment of Special Weekly Allowances in Terms of Section 48 of the Act (1) The notification to a claims officer by a contributor in terms of section 48 (2) shall be in the form of and contain the particulars specified in Annexure UF 79. (2) The statement which an employer may be required to transmit weekly to a claims officer in terms of section 48 (3) shall be in the form of and contain the particulars specified in Annexure UF 80. 15 Value of Remuneration in Kind (1) Should remuneration in kind be paid to a contributor, the value thereof is calculated as follows in terms of section 50 (3), read with section 62 (1) (m) of the Act: (a) In the case of a contributor who is employed otherwise
than in agriculture and that contributor is provided by his employer with
food or quarters or with both food and quarters, the weekly or monthly value
of such food or quarters, or food and quarters, for the purposes of section
50 of the Act, shall, in respect of food, be at the rate of 17 per cent of
the weekly or monthly amount, as the case may be, of the earnings paid or
payable in cash to such contributor, and shall, in respect of quarters, be at
the rate of 8 per cent of the amount of such earnings and, in respect of food
and quarters, be at the rate of 25 per cent of the amount of such earnings; (b) in the case of a contributor who is employed in
agriculture, the value of remuneration in kind is in terms of section 50 (3),
read with section 62 (1) (m) of the Act, determined as the greater of- (i) 30 per
cent of the monthly earnings paid or payable to a contributor in cash; or (iii) the
amount of one hundred rand. (2) Notwithstanding the provisions of subregulation (1) an employer and a contributor in agriculture can in terms of section 50 (3), read with section 62 (1) (m) of the Act, agree in writing on the value of remuneration in kind subject to such value being not less favourable as determined in paragraph (b) (ii) of subregulation (1) and the agreed value shall be valid for the purposes of section 50 of the Act. [Regulation 15 substituted by GN R643 of 16 April 1993.] 15A Safe-keeping of Agreement In terms of section 62 (1) (m) of the Act it is prescribed that an employer shall keep a copy of the written agreement as intended in subregulation 15 (2) for a period of three years after the date of termination of employment of the contributor. [Regulation 15A inserted by GN R643 of 16 April 1993.] 16 Repeal and Savings (1) The Regulations published under Government Notice R1619 of 27 July 1979, as amended by the Regulations published under Government Notices R2667 of 30 November 1979, R1532 of 25 July 1980, R2089 of 17 October 1980, R1862 of 4 September 1981, and R2204 of 15 October 1982, are hereby repealed. (2) Anything done under any provisions of a regulation repealed by subregulation (1) shall be deemed to have been done under the corresponding provisions of these Regulations. 17 Commencement These Regulations shall come into operation on the 1st day of May 1983. Annexures Annexure UF 1 [Annexure UF 1 amended by GN R2613 of 2 December 1983, GN R2775 of 21 December 1984, GN R2487 of 8 November 1985, GN R2427 of 21 November 1986, GN R419 of 11 March 1988 and GN R1707 of 27 July 1990.] NOTIFICATION BY
EMPLOYER IN TERMS OF SECTION 28 (1) To the Unemployment Insurance Fund Laboria Buildings Paul Kruger Street P.O. Box 1851 Pretoria 0001 The following particulars are furnished in terms of
section 28 (1) of the Unemployment Insurance Act, 1966, and are certified to
be correct. Date ---------------------------------------------------------- ................
..................................................................................... Signature of employer or duly authorised agent 1. Date on which contributor(s) first
employed.............................................................................................................. 2. Name under which business is carried on (block
letters)............................................................................................... 3. Address to which correspondence is to be sent
........................................................................................................... 4. Full christian name(s), surname, residential
address/es (not P.O. Box) and identity number(s) of OWNER or PARTNERS. In the
case of a COMPANY or CLOSE CORPORATION indicate registered name
................................... ............................................................................................................................................................................................. ............................................................................................................................................................................................. ............................................................................................................................................................................................. 5. (a) Address where business premises are situated
......................................................................................................... (b) Magisterial district in which business premises
are
situated......................................................................................... 6. Nature of
business....................................................................................................................................................... 7. Number of contributors employed
............................................................................................................................. 8. If this return is in respect of the head office of
a business, state- (a) names
and addresses of branches
....................................................................................................................... ....................................................................................................................................................................................... .------------------------------------------------------------------------------------------------------------------------------------------------------------- . .------------------------------------------------------------------------------------------------------------------------------------------------------------- . (b) whether or not branches will be responsible for
submission of returns and contributions
direct.................................. 9. If this return is in respect of a branch of the
business, state- (a) name
and address of head office (in the Republic)
.............................................................................................. (b) whether
returns and contributions will be submitted- (1) direct
................................................................................................................................................................ or (2) through
your head office
................................................................................................................................... N.B.-A separate return should be rendered in respect of
each individual business unless permission is obtained to submit a
consolidated return. Annexure UF 3 [Annexure UF 3 amended by GN R1235 of 17 June 1983, GN R2487 of 8 November 1985 and GN R2427 of 21 November 1986.] To the Unemployment Insurance Fund Laboria Buildings Paul Kruger Street P.O. Box 1851 Pretoria 0001 Return for the month -------------- only In
terms of section 29 (3) of the Unemployment Insurance Act, 1966, 1 forward
herewith the total amount as shown in column F hereunder, being all
contributions due in respect of myself and the contributors employed by me
during the above-mentioned month. I
hereby certify that all details contained herein are true and correct. Date --------------------------------------------------------- ................
..................................................................................... Signature of employer or duly authorised agent If
no contributors were employed during the month, state date in the adjacent
space when a contributor was last employed and return this form. Date
....................................................................................
Annexure UF 7 CONTRIBUTOR'S CHECK CARD Contributor's
record card of the undermentioned contribution handed in at Office stamp .................................................................... Signature of receiving officer IDENTITY PARTICULARS Contributor's surname
.......................................................................................................................................................... Contributor's first name
....................................................................................................................................................... Identity/Reference Book No.
............................................................................................................................................... UF Serial No.
....................................................................................................................................................................... ......................................................................... Specimen signature of contributor Annexure UF 64 [Annexure UF 64 inserted by GN R643 of 16 April 1993.] APPLICATION TO
BE EXEMPTED FROM LIABILITY TO CONTRIBUTE TO THE UNEMPLOYMENT INSURANCE FUND
IN TERMS OF SECTION 2 (5) (a) (1) OF THE ACT The Unemployment Insurance Commissioner P.O. Box 1851 PRETORIA 0001 I
hereby, in terms of section 2 (5) (a) (i) of the Unemployment Insurance Act,
1966, make application that the persons or category of persons mentioned
below not be regarded as contributors in the application of the said Act: 1. Name
of
employer......................................................................................................................................... 2. Address........................................................................................................................................................... ......................................................................... Postal code
...................................................................... Telephone number
......................................................... Dialing code
...................................................... 3. My
business is already registered with the Unemployment Insurance Fund and the
reference number is........... 4. Nature
of
business........................................................................................................................................... 5. Date
of commencement of
business................................................................................................................ 6. Particulars
of class of persons or business or area in respect of whom or of which
exemption is required: ..................................................................................................................................................................... 6.1 Number
of employees employed .......................................................................................................... 6.2 The
activities of the business are seasonal bound and the nature of the seasonal
activities and the duration of the seasons are as follows: ............................................................................................................................................................ ............................................................................................................................................................ * In
the event of application for exemption on financial grounds, full details of
your financial position must accompany this application. ** Any
other reason in motivation of your application must be attached, please. I
declare that before I lodged this application, I discussed the matter with
the employees concerned who indicated that they are also desirous to be
exempted from the provisions of the Act. ....................................................................................................... ....................................................................................................... Date
............................................................................................... Annexure UF 74 [Annexure UF 74 amended by GN R960 of 20 May 1988.]
Annexure UF 79 [Annexure UF 79 amended by GN R1235 of 17 June 1983.] APPLICATION FOR SPECIAL WEEKLY ALLOWANCE
IN TERMS OF SECTION 48 To the Claims Officer Department of Manpower ..................................................................................................... I
hereby apply for a special weekly allowance in terms of section 48 of the
Unemployment Insurance Act, 1966, and notify you that, after having become
unemployed, I have accepted employment at less than half the average weekly
earnings received by me during the period of three months immediately prior
to the date upon which I became unemployed. I
declare that the information given below is true and correct in every
respect. .............................................................................. Signature of applicant Date
........................................................................ DETAILS TO BE FILLED IN BY APPLICANT 1. Full name (block letters) ........................................................................................................................................... 2.
Address...................................................................................................................................................................... 3. Identity/Reference Book No.
.................................................................................................................................... 4.
My present employer is: (a)
Name
....................................................................................................................................................................... (b)
Address..................................................................................................................................................................... 5. I am employed as
...................................................................................................................................................... 6. My present rate of earnings
is.................................................................................................................................... 7.
I was employed as follows during the three months immediately prior to the
date I became unemployed:
Annexure UF 80 SPECIAL WEEKLY
ALLOWANCE IN TERMS OF SECTION 48 To the Claims Officer Department of Manpower
I
hereby certify that ................................................................................................................................................. (Name of employee) whose identity/reference book number is
................................ has been employed by me as a
..........................during the week ended
.....................................................................and that
the undermentioned particulars regarding him are correct in respect of that
week:
........................................................................................... Signature of employer Date
................................................................................. Annexure UF 85 [Annexure UF 85 amended by GN R1235 of 17 June 1983.] NOTIFICATION OF
EMPLOYMENT OF PERSONS NOT IN POSSESSION (Use form
for more than one contributor if more than one card is required) The Unemployment Insurance Fund Laboria Buildings Paul Kruger Street P.O. Box 1851 Pretoria 0001 I
have to inform you that the following persons who will be contributors to the
Unemployment Insurance Fund, were taken into my employment on the dates
specified and have indicated that they are not in possession of contributors'
record cards:
*
Insert (a), (b), (c), (d), (e) or (f), whichever is applicable, in front of
each number entered. Trading
name and address of business (in block letters)
................................................................................................. ............................................................................................................................................................................................. Employer's UIF Registration No. (See return form UF
3) ............................................................................................. Employer's telephone No
................................................................. I
hereby certify that the above particulars are correct and that the identity
numbers and other numbers in column 3 and full names have been verified from
the identity documents issued in terms of the Population Registration Act,
reference books or from other identity documents produced by the contributors
concerned. ............................................................................................ Signature of employer or duly authorised agent Date
or date stamp ........................................................ Annexure UF 86 [Annexure UF 86 amended by GN R1235 of 17 June 1983, by GN R960 of 20 May 1988 and by GN R1976 of 22 October 1993.]
Annexure UF 87 [Annexure UF 87 amended by GN R960 of 20 May 1988 and by GN R1976 of 22 October 1993.]
Annexure UF 92 APPLICATION FOR MATERNITY BENEFITS IN TERMS OF
SECTION 37 To the Claims Officer Department of Manpower 1. I hereby apply for
maternity benefits in terms of section 37 of the Unemployment Insurance Act,
1966, and declare that: *(a) I am pregnant; (b) I stopped work and since that
date I have not been entitled to, nor have I received, from any employer one
third or more of my normal earnings; *(c) I gave birth to a child and the
particulars are shown in the attached completed form UF 94. I further declare that the
information given by me on this form is true and correct and that I am aware
that it is an offence to knowingly make a false statement on this form. *
Delete whichever is not applicable. 2. Surname (in block letters) -------------------------------------- 3. First names-------------------------------------------- 4. Address -------------------------------------------------------------------------------------------------------------------------- 5. Identity/Reference book number------------------------------- 6. Race --------------------------------------------------- 7. Date of birth ---------------------------------------------------- 8. Trade or occupation --------------------------------- 9.
Details of employment:
*
Indicate per week/per month. 10. Date on which you stopped working------------------------- 11. Are you still in employment? (Yes/No)
---------- 12. If you have returned to work, state date--------------------- 13. Have you ever applied for unemployment/maternity/illness benefits? (Yes/No) ---------------- If so state: (a) Office ----------------------------------- (b) Date of application-------------------------------------------------- (c) UF Serial No. ---------------------------------------- (d) Name under which applied --------------------------------------------------------------------------------------------------------- Witness ------------------------------------------------------------------- ------------------------------------------------------------- 14.
Medical certificate (to be completed by a medical practit ioner if applicant
is still pregnant): I (name of medical practitioner) -------------------------------------------------------- Qualifications --------------------- Address ----------------------------------------------------------------- hereby
certify that ..................................................... was (name of applicant) examined by me, that in my opinion she is pregnant,
and that from my examination and the information furnished by her, I consider
the expected date of her confinement to be Date --------------------------------------------------- -------------------------------------------------------------------------- Signature of medical practitioner Note.-If child has already been born, form UF 94 should be
completed. Annexure UF 92A [Annexure UF 92A inserted by GN R2412 of 30 October 1987 and substituted by GN R643 of 16 April 1993.]
Annexure UF 93 DECLARATION BY APPLICANT FOR PRE-NATAL MATERNITY
BENEFITS To the Claims Officer Department of Manpower ................................................................................... 1. I declare that I am still
pregnant and have not worked since the date of my application for maternity
benefits. I further declare that since that date I have not been entitled to,
nor have I received, from any employer one third or more of my normal earnings.
I furnish the following particulars which I declare to be true and correct
and I am aware that it is an offence to knowingly make false statements on
this form. 2.
Surname (block letters)
............................................................................................................................................. 3.
First names
............................................................................................................................................................... 4. Residential address
..................................................................................................................................................... 5. Address to which cheque should be posted
.................................................................................................................. 6. Identity/Reference Book No.
.................................................................................................................................... 7. Expected date of confinement
.................................................................................................................................. Witness ................................................................................ Date
.....................................................................................
........................................................................................... (Signature of applicant) Annexure UF 93A [Annexure UF 93A inserted by GN R2412 of 30 October 1987.] L.W. VORM MOET OP OF NA
...................................................................................................
VOLTOOI WORD N.B. FORM TO BE COMPLETED ON OR AFTER VERKLARING DEUR PERSOON WAT AANSOEK DOEN OM
AANNEMINGSVOORDELE DECLARATION BY APPLICANT FOR ADOPTION BENEFITS
.............................................................................................................................................................................................
Annexure UF 94 [Annexure UF 94 amended by GN R1235 of 17 June 1983.] DECLARATION BY APPLICANT FOR POST-NATAL MATERNITY
BENEFITS To the Claims Officer Department of Manpower ----------------------------------------------- 1. 1 declare that I have not worked since I was last
employed immediately prior to the date of my application for maternity
benefits except as shown in item 6 hereunder and that I have not been
entitled to, nor have I received, from any employer one third or more of my
normal earnings. I further declare that a child was born to me and that the
particulars shown in the Notification of Birth hereunder refer to that child.
The information given by me on this form is true and correct and I am aware
that it is an offence to knowingly make false statements on this form. 2.
Surname (block letters)
............................................................................................................................................. 3.
First names ............................................................................................................................................................... 4.
Address
..................................................................................................................................................................... 5. Identity/Reference Book No.
.................................................................................................................................... 6. If you have returned to work, state
date..................................................................................................................... 7.
Address to which cheque should be posted
.................................................................................................................
Date---------------------------------------------------------------------------------------------------------------------------------------- Signature of applicant NOTIFICATION OF BIRTH Name of medical
practitioner/midwife
.................................................................................................................................. Qualifications ---------- .......................................------- Address
........................................................................................ I hereby certify that ............................................................................................................................................................. (Name of applicant) gave birth to a *live/still-born child on
................................................................................................................................. (Date of birth of child) Date --------------------------------------------------------- .....
............................................................................................. Signature of medical practitioner or midwife* _____________________ *
Delete whichever is not applicable. Annexure UF 95 DECLARATION BY APPLICANT FOR POST-NATAL MATERNITY
BENEFITS To the Claims Officer Department of Manpower ......................................................................................... 1.
I declare that I have not worked since I was last employed immediately prior
to the date of my application for maternity benefits except as shown in item
6 hereunder and that I have not been entitled to, nor have I received, from
any employer one third or more of my normal earnings. The information given
by me on this form is true and correct and I am aware of the fact that it is
an offence to knowingly make false statements on this form. 2.
Surname (block letters)
............................................................................................................................................. 3.
First names ............................................................................................................................................................... 4.
Address
..................................................................................................................................................................... 5. Identity/Reference Book No. ----------------------------------------- ............................................................................. 6. If you have returned to work, state date
.................................................................................................................... 7.
Address to which cheque should be
posted................................................................................................................... 8. I gave birth to a
*live/still-born child on
................................................................................................................... Witness
................................................................................ Date ------------------------------------------------------------------------------------------------------------------------------------------------------------- .................................................................................. Signature of applicant ______________________ *
Delete whichever is not applicable. Annexure UF 103 UNEMPLOYMENT REGISTER/COMPUTATION SHEET (SECTION 35) UF
Serial No.
....................................................................................................................................................................... Identity/Reference Book No.
............................................................................................................................................... Name
................................................................................................................................................................................... Address
................................................................................................................................................................................ Race ------------------------------------------------------------------------- Sex ----------------------------------------------------- Married or single ----------------------------------------------------------- Date of birth ------------------------------------------ Trade or occupation
............................................................................................................................................................. Date of application -------------------------------------------------------- Office -------------------------------------------------- I declare
that I am unemployed and have not been employed since I last signed this
register and that I have not received remuneration for any work performed
without notifying the claims officer. I
am aware of the fact that it is an offence to sign the register while I am in
employment. Date --------------------------------------------------------------------- -------------------------------------------------------------- Signature of contributor Annexure UF 103A UNEMPLOYMENT INSURANCE ACT, 1966 (SECTION 35) UNEMPLOYMENT REGISTER FOR RURAL BENEFICIARIES UF Serial No.
...................................................................................................................................................................... Identity/Reference Book No.
.............................................................................................................................................. Surname
.............................................................................................................................................................................. Christian names (in full)
..................................................................................................................................................... Address .............................................................................................................................................................................. Date of birth ----------------------------------------------------------- Married or single ------------------------------------------- Race -------------------------------------------------------------------- Sex ------------------------------------------------------------ Office of the Claims Officer
............................................................................................................................................... I declare
that I am unemployed and have not been employed since I last signed the
register and that I have not received remuneration for any work performed
without notifying the Claims Officer. I am aware of the fact that it is an
offence to sign this register while I am in employment. Date -------------------------------------------------------------------- --------------------------------------------------------------- Signature of contributor Annexure UF 107 [Annexure UF 107 amended by GN R1235 of 17 June 1983.] APPLICATION FOR ISSUE OF A CONTRIBUTORS' RECORD CARD
IN TERMS OF REGULATION 8 (3) To The Unemployment Insurance Fund Laboria Buildings (P.O. Box 1851) Paul Kruger Street Pretoria 0001 I hereby apply, in terms of
regulation 8 (3), for the issue of a Contributor's Record Card in respect of
the undermentioned contributor and declare that: *(a) The original has been
lost/destroyed; or *(b) to my knowledge a card has not been previously issued
to the contributor. The information given by me on this form is to my
knowledge true and correct. I attach a
*postal/money order for fifty cents (50c). Date ----------------------------------------------------------------- ------------------------------------------------------------------- Signature of applicant. If application is not made by contributor personally state capacity in which
application is made. -------------------------------------------- __________________ *
Delete whichever is not applicable. 1. Surname of contributor
.............................................................................................................................................. 2.
Full other names
........................................................................................................................................................ 3. Maiden name (in case of married woman)
.................................................................................................................. 4. Identity/Reference Book
No....................................................................................................................................... 5. Race -------------------------------------- 6. Sex --------------------------------------- 7. Date of birth
.......................... 8. Ordinary rate of earnings
...........................................................................................................
(state p.w. or p.m.) 9. Present address of applicant
....................................................................................................................................... 10.
Names and addresses of present/previous employers:
Note.-Proof of employment with at least one employer to
be submitted. 11. State circumstances leading to the loss or
destruction of previous contributor's record card
...................................... 12. State reason for this application i.e. purpose
for which card is required at this stage
................................................. Annexure UF 123 [Annexure UF 123 amended by GN R1235 of 17 June 1983.] APPLICATION FOR BENEFITS IN TERMS OF SECTION 35 To the Claims Officer Department of Manpower ............................................................................................................................................................................................. 1. I hereby apply for
unemployment benefits in terms of section 35 of the Unemployment Insurance
Act, 1966, and declare that I am unemployed and that the information given by
me in this form is true and correct in every respect. I am aware of the fact
that it is an offence to make a false statement on this form. 2. Surname (in block letters) ---------------------------------------------- 3. Christian names
................................................. 4. Address ---------------------------------------------------------------------- 5. Identity/Reference Book
No........................... 6. Race ------------------------------------------ 7. Sex ----------------------- 8. Date of birth
.............................................. 9. Trade or occupation ------------------------------------------------------------- 10. Married or single
................................... 11. Details of employment:
* Indicate p.w. or p.m. 12.
Have you ever applied for unemployment/maternity/illness benefits: (Yes or
No) .................................................. If so state: (a) Office ------------- (b)
Date applied ---------------- (c) UF Serial No ----------------- (d) Name under which applied
..................................... 13. If last employer paid wages in lieu of notice,
state period: From ------------------------- to ..................................... 14. Are you capable of and available for work? (Yes
or No) .......................................................................................... Date ----------------------------------------------------------------- ........................................................................................ Signature of applicant Annexure UF 125
The Claims Officer Department of Manpower ......................................................................... UNEMPLOYMENT INSURANCE ACT, 1966 STATEMENT IN RESPECT OF PAYMENTS MADE TO THE
UNDERMENTIONED CONTRIBUTOR WHO IS STILL IN MY EMPLOYMENT BUT IS UNABLE TO
WORK DUE TO ILLNESS OR PREGNANCY (A) In terms of section 33
(3) of the above-mentioned Act I forward herewith the contributor's record card
(UF 74) of the undermentioned contributor and hereby certify that since
................................ (date in full) the contributor has received
from me less than one third of his/her normal remuneration and will not,
during the remainder of the period of absence due to illness or pregnancy,
receive from me one third or more of his/her normal remuneration. (B) The contributor is expected to return to work on --------------------------- /the contributor resumed duty on
................. Date ---------------------------------------------------------------- ........................................................................................ Signature of employer or duly authorised agent Full names of contributor
..................................................................................................................................................... Identity No./Reference Book No.
......................................................................................................................................... Annexure UF 126 [Annexure UF 126 amended by GN R2412 of 30 October 1987, by GN R2667of 4 December 1987 and by GN R1884 of 9 August 1991.] BETALING AAN AFHANKLIKE VAN AFGESTORWE BYDRAER PAYMENT TO DEPENDANT OF DECEASED CONTRIBUTOR AANSOEK DEUR WEDUWEE OF WEWENAAR APPLICATION BY WIDOW OR WIDOWER Aan die Afdelingsinspekteur
Departernent van Mannekrag/To the Divisional Inspector Department of Manpower ---------------------------------------------------------------------------------------------- Hierby doen ek aansoek om betaling ingevolge artikel 38 van die
Werkloosheidversekeringswet, 1966, en verklaar ek dat ek die enigste
weduwee/een van . . . . . weduwees/wewenaar* van ondergenoemde afgestorwe
bydraer is, dat ek nie van hom/haar* geskei was nie en dat die inligting wat
ek op hierdie vorm verstrek, juis en korrek is. I hereby apply for a payment in terms of section 38 of the
Unemployment Insurance Act, 1966, and declare that I am the only widow/one of
. . . . . widows/widower* of the undermentioned deceased contributor,
that I was not divorced from him/her* and that the information given by me in
this form is true and correct. ----------------------------------------------------------------------------------------------
Datum/Date Handtekening
van weduwee/wewenaar*/Signature of widow/widower* * Skrap wat nie van toepassing is nie. / Delete whichever is not
applicable. A. Moet deur die
applikant ingevul word:/To be filled in by applicant: 1. Volle naam
van applikant (blokletters)/Full name of applicant (block letters) -------------------------------------------------------------------------------------------- 2. Adres/Address
------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- 3. Persoons-/Identiteits-/Bewysboeknommer
van applikant Identity/Reference
book number of applicant ------------------------------------------------------------------------------------- 4. Volle naam
van afgestorwe bydraer (blokletters)/Full name of deceased contributor
(blockletters) -------------------------------------------------------------------------------------------- 5. Laaste
woonadres van afgestorwe bydraer/Last residential address of deceased
contributor -------------------------------------------------------------------------------------------- 6. Persoons/Identiteits-/Bewysboeknommer van
afgestorwe bydraer/Identity/Reference book number of deceased contributor -------------------------------------------------------------------------------------------- 7. Datum van
oorlyde/Date of death -------------------------------------------------------------------------------------------------- C. Dokumente wat aangeheg moet word: Documents to be attached: 1. Bydraersverslagkaart van die afgestorwe
bydraer/Contributor's record card of the deceased contributor. 2. Die
doodsertifikaat, die lykskouingsertifikaat, of die begrafnisorder wat op die
dood van sodanige bydraer betrekking het. The death certificate, post-mortem certificate or
burial order relating to the death of such contributor. 3. Sertifikaat in die vorm van U F 128 van
sy/haar laaste werkgewer. Certificate from his/her last employer in the form of
U F 128. 4. Huweliksertifikaat/Marriage certificate
SLEGS VIR AMPTELIKE
GEBRUIK/FOR OFFICIAL USE ONLY. Gesertifiseer dat die ondersteunende (vermeld dokumente)/Certified
that supporting (describe documents) -------------------- ---------------------------------------------------------------------------------------------- wat die betrokke name en datums hierop bevestig, aan my getoon
is/confirming relevant names and dates hereon were produced to me. Datum/Date --------------------------- Handtekening/Signature ------------------------ Rang/Rank ------------------------------- Annexure UF 127 [Annexure UF 127 amended by GN R1235 of 17 June 1983, by GN R2412 of 30 October 1987 and by GN R2667of 4 December 1987.] PAYMENT TO DEPENDANTS OF DECEASED CONTRIBUTOR APPLICATION BY PERSON OTHER THAN WIDOW/WIDOWER To the Divisional inspector, Department of Manpower
....................................................................................................... ---------------------------------------------------------------------------------------------- I hereby apply for a payment in terms of section 38 of the
Unemployment Insurance Act, 1966, and declare that the information given
below is true and correct to the best of my knowledge and belief. ---------------------------------------------------------------------------------------------- Date Signature
of Applicant A. TO BE FILLED IN BY APPLICANT: 1. FULL NAME OF APPLICANT (block letters) --------------------------------------------------------------------------------
2. STATE WHETHER MR., MRS, OR MISS -------------------------------------------------------------------------------------- 3. ADDRESS -------------------------------------------------------------------------------------------------------------------------- 4. IDENTITY/REFERENCE BOOK NUMBER OF APPLICANT -------------------------------------------------------------- 5. FULL NAME OF DECEASED CONTRIBUTOR (block
letters) -------------------------------------------------------------
6. LAST RESIDENTIAL ADDRESS OF DECEASED
CONTRIBUTOR -------------------------------------------------------
7. IDENTITY/REFERENCE BOOK NUMBER OF DECEASED
CONTRIBUTOR ------------------------------------------- 8. DATE OF DEATH ---------------------------------------------------------------------------------------------------------------- 9. RELATIONSHIP (if any) OF APPLICANT TO
DECEASED CONTRIBUTOR -------------------------------------------
10. IF APPLICATION MADE FOR THE BENEFIT OF A
PERSON OTHER THAN THE APPLICANT STATE: (a) Full name of such person (block letters) ---------------------------------------------------------------------------- (b) Address -----------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------- (c) Relationship of such person to deceased
contributor -------------------------------------------------------------- (d) Where application is made on behalf of a
child under the age of 17 years at the date of death of deceased contributor,
give full names and addresses of any other children, including any adopted
children of deceased contributor under 17 years of age at the date of death
of deceased contributor. ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- B. DOCUMENTS TO BE ATTACHED: I attach hereto: 1. Contributor's record card of the deceased contributor; 2. The death certificate, post mortem certificate or burial order
relating to the death of such contributor; 3. In the case
of an application on behalf of a child or children, including any adopted
children, under the age of 17 years at the date of death of the deceased
contributor, the birth certificate(s) of such Child or children; 4. Certificate from the last employer of the deceased contributor in
the form of U.F. 128; 5. An affidavit giving reasons why payment should be made to me. NOTES: (i) The
affidavit should give the full grounds upon which the application is based
and include a declaration in regard to the person for whose benefit the
payment is claimed, stating - (a) whether such person was wholly or mainly
dependent on the deceased contributor for the necessities of life, and (b) the amount and sources of all income of
such person as at the date of death of the deceased contributor. (ii) Where
the applicant, or the person, on whose behalf application is made, is in
receipt of a grant from the Department of Health, Welfare and Pensions or
other State Department or is being cared for in an institution, particulars
of the grant or the name of the institution should be given. FOR OFFICIAL USE ONLY. Certified that supporting (describe documents) --------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ confirming relevant names and dates hereon were
produced to me. Date --------------------------------------------- Signature
----------------------------------------------------------- Rank --------------------------------------------------------------- Annexure UF 128 PAYMENTS TO DEPENDANTS OF DECEASED CONTRIBUTOR FORM TO BE COMPLETED BY EMPLOYER IN RESPECT OF
DECEASED CONTRIBUTOR Note.-An employer who employed the deceased contributor
must complete the form on request and thereafter return it to the person who
requested its completion. Name of employer
............................................................................................................................................................... Address of
employer............................................................................................................................................................. Employer's UIF Registration
No.
......................................................................................................................................... I forward herewith, as
required by regulation 13 (3) under the Unemployment Insurance Act, 1966, the
contributor's record card of the undermentioned deceased contributor, and
certify that the following information in respect of such contributor is true
and correct. 1.
Full names of deceased contributor (block letters)
..................................................................................................... 2.
Identity/Reference Book No. of deceased contributor
............................................................................................... 3.
Period(s) in my employ as a contributor (any change in earnings to be
indicated):
4.
If during period(s) mentioned in 3 above no contributions were paid, state:
---------------------------------------- Signature of employer Date ------------ Annexure UF 139 APPLICATION FOR FURTHER BENEFITS IN TERMS OF SECTION
35 (14) The Claims Officer Department of
Manpower................................................... - 1. I hereby apply for the payment of further benefits
in terms of section 35 (14) of the Unemployment Insurance Act, 1966, and
declare that I am unemployed and that the information given by me in this
form is true and correct in every respect. I am aware of the fact that it is
an offence to make a false statement in this form. 2. Surname (in block letters) ------------------------------------- 3. First names --------------------------------------------------- 4. Address ---------------------------------------------------------- 5. Identity/Reference Book No.-------------------------------- 6. Race ------------------------------------------ 7. Sex ------------------------------------- 8. Date of birth --------------------- 9. Trade or occupation ------------------------------------------- 10. Married or single ------------------------------------------- 11. Details of employment:
*
Indicate per week or per month. 12. Are you capable of and available for work?
(Yes/No)............................................................................................... I have made efforts, details of which are given hereunder to obtain
employment, but have been unsuccessful for the reasons indicated in the space
provided below. Full
details of efforts made to find employment Reasons
why not successful ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- Signature of applicant Date ----------------------------------------------------------------------------------------------- Annexure UF 140 [Annexure UF 140 amended by GN R960 of 20 May 1988 and by GN R1976 of 22 October 1993.]
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