Form Sc2 - Statutory Sick Pay (Ssp) Employee'S Statement Of Sickness
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2Statutory Sick Pay (SSP)
Employee’s statement of sickness
About this form
Statutory Sick Pay (SSP) is money paid by employers to their employees who satisfy the conditions for
payments when they are ill and unable to work.
Please fill in ‘Your statement’ below when you have been sick for four days or more in a row.
Your statement
About you
What date did you last work before your sickness began?
Surname or family name
DD MM YYYY
First name(s)
What time did you finish work on that date?
(enter time in 24 hours)
Title – enter MR, MRS, MISS, MS, or other title
Was your sickness caused by an accident at work or an
industrial disease?
National Insurance number
No
Yes
If you answered ‘Yes’, you may be able to get Industrial Injuries
Date of birth DD MM YYYY
Disablement Benefit. If you want information about claiming
this benefit, ask at any Jobcentre Plus office or go to
www dwp gov uk
Clock or payroll number
Signature
About your sickness. Please give brief details
Date DD MM YYYY
What date did your sickness begin? DD MM YYYY
Phone number
What date did your sickness end?
If you do not know, please leave this blank.
DD MM YYYY
The dates you put in these two boxes may be days you do
not normally work. If you are sick for more than seven
days, your employer may ask you for a medical statement
of fitness for work ‘fit note’ from your doctor.
What to do next
Please:
• give your completed form to your employer. It will help them to decide if you can get SSP
• keep a copy for your own information.
If you can get SSP, your employer will pay you in the same way they usually pay your wages.
If you cannot get SSP, your employer must give you form SSP1 to tell you why. You can use form SSP1 to
support a claim for Employment and Support Allowance.
If you disagree with your employer’s decision and you have also looked at the further information on the
HMRC website, you can ask HM Revenue & Customs for a decision about your entitlement. You must do this
within six months of the first day that you are notified of your employer’s decision. Phone our Disputes
Please turn over
Team on 0191 225 5221.
SC2
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HMRC 10/12
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Parent category: Financial