Claim Form For Unemployment Benefit - Eecu (Page 2 of 4) in pdf

Claim Form For Unemployment Benefit - Eecu Page 2

last emplOyment Details

Name and address of last employer:

Telephone number:

Date last worked:

How long with that employer?

Employed from:

to:

occupation prior to becoming unemployed:

How long in that occupation?

years

months

When did you first learn you were to become unemployed?

Nature of employment:

Permanent

Part-time

Contract

Seasonal

Casual

other

if ‘other’, please provide details)

on average, how many hours per week did you work?

reason for leaving job:

Dismissed

retrenched

resigned

End of contract

End of season

other

if ‘other’, please provide details:

CuRRent emplOyment status

on what date did you register as unemployed with Centrelink:

Have you obtained alternative employment?

Yes

If ‘yes’, when did/will you commence?

unemplOyment CeRtiFiCate

to be completed by Centrelink or Registered Job network agency

This is to certify that:

residing at:

registered as being unemployed on:

Jobseeker Number:

is this person still registered as unemployed?

Yes

Type of benefit granted:

Newstart Allowance

Parenting payment

Youth allowance

other

if not in receipt of benefits, please advise reason:

Has a Separation Certificate been provided by the previous employer?

Yes

if ‘yes’, please provide us with a copy.

if ‘no’, please advise what other documentation has been provided:

Signed Registrar:

Branch Stamp:

Date:

impORtant nOtes tO insuReD

• The date of acceptance is generally the date you register as being unemployed with Centrelink. As per your policy, payments will

commence following the expiry of your policy waiting period (subject to our acceptance of your claim and you complying with the

policy terms and conditions).

• You must continue to actively seek employment and forward the necessary documentation to show you are currently registered

with Centrelink as being unemployed. We would suggest you forward such documentation on a regular fortnightly or monthly basis.

• Please ensure you have fully completed the claim form as an incomplete claim form may cause delays in processing your claim.

Claim Form For Unemployment Benefit - Eecu Page 2

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