Form Sc2 - Employee'S Statement Of Sickness - Hm Revenue & Customs
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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 employees who are away from work because they
are sick. 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.
Your signature
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 certificate
from your doctor. Medical certificates are also called sick
notes or doctor’s statements.
What to do next
Please:
• give your completed form to your employer. It will help them 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 will give you form SSP1to tell you why. You can use form SSP1 to
claim Employment and Support Allowance which replaced Incapacity Benefit for new customers from
27 October 2008.
If you disagree with your employer’s decision you can ask HM Revenue & Customs for a decision about
your entitlement.
Please turn over
SC2
Page 1
HMRC 09/08
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