Employer Name: UIF reference Number : I , Identity

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UNEMPLOYMENT INSURANCE ACT 63 OF 2001, AS AMENDED

RESPONSE TO CORONA VIRUS

EMPLOYER DECLARATION

Employer Name:

UIF reference Number :

I __________________________________________, Identity Number________________________________________

(Employer’s full name & surname)

Hereby declare that the Company and the employee,

____________________________ Identity Number _______________________________________________

(Employee’s full name & surname)

have agreed that the employee must self quarantine/isolate and not

report for duty as a measure to curb the spread of Corona virus from _______________to_______________

that the employee has exhausted their sick leave credits and needs to apply for UIF benefits .

The application for UIF benefits lodged is for the period stated above.

Required Documents to be submitted by EMPLOYEE through the normal application channels:

UI 2.2 (Doctors portion does not need to be completed for Quarantine/isolation)

UI 2.8 (Banking Details)

UI 2.7 (Leave Income)

UI 19 and Salary Schedule (if applicable)

Signed at: ___________________________________ on the ___________________________

COMPANY STAMP (if available)

EMPLOYEE’S SIGNATURE

___________________________________________________

EMPLOYER SIGNITURE/ EMPLOYER REPRESENTATIVE