Form Ui2.7 - Remuneration Received By The Employee Whilst Still In Employment

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UI-2.7
UNEMPLOYMENT INSURANCE FUND
REMUNERATION RECEIVED BY THE EMPLOYEE WHILST STILL IN
EMPLOYMENT
To:
The Claims Officer
Statement in respect of payment made to the undermentioned Contributor who is still in my
employment but is unable to work due to Illness, Maternity leave or the Adoption of a child.
Full names of contributor:
/
Employers UIF Reference No.
ID No of contributor
(A) In terms of section 19(1), 24(2) and 27(3) of the abovementioned Act,
I hereby certify that since (full date)
/
/
, the contributor is on
Sick leave
Maternity leave
Leave due to the adoption of a child and
has
will
receive(d) the following remuneration
Gross remuneration
Gross remuneration
Periods during which different rates of
received whilst on leave
(prior to confinement)
remuneration were received
(PM/PW)
Per Month / Per Week
From
To
From
To
From
To
From
To
From
To
From
To
(B)
The contributor is expected to return to work on __________/__________/___________.
(C)
The contributor returned to work on __________/__________/___________.
DATE: ____________________
_________________________________________________
SIGNATURE OF EMPLOYER OR AUTHORISED AGENT
BUSINESS STAMP
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