Sickness Or Temporary Disablement Benefit Claim For Benefit Labour Act 1386 Legal Draft Template
| Category | Labour Act |
| Format | Rich Text |
| File name | Sickness or Temporary Disablement Benefit Claim for Benefit-Labour Act-1386.rtf |
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SICKNESS OR TEMPORARY DISABLEMENT BENEFIT CLAIM FOR BENEFIT
I…………………s/w/d of ………………………Insurance No……………….hereby state that I was certified sick/ temporarily disabled from a.m./p.m. on the…………..day of……………20….and I have not been at work since a.m./p.m. on the day of 20………
I no longer claim to be sick/temporarily disabled from …….day of 20………….and I shall/did not take up any work for remuneration before that day.
I claim benefit accordingly. I desire payment in cash at local office/by
money order present/last employer………..Department………………..
Occupation…………….shift (if any) present address…………….
Signature or thumb impression
Local Office
*Strike out if not applicable, and then, before resuming work, a final certificate must be obtained.
ACCIDENT CASE ONLY
not been given to the employer, state briefly on a separate paper how the accident happened.
Signature or thumb impression
SICKNESS OR TEMPORARY DISABLEMENT BENEFIT CLAIM FOR BENEFIT
I, , s/w/d of Insurance
No declare that because of sickness/temporary
disablement, I have not been at work since the date of last/first certificate sent to you.
I claim benefit accordingly. I desire payment in cash at local office/by money order.
Signature or thumb impression
Date Local office Present Address
CLAIM FOR PERMANENT DISABLEMENT BENEFIT
I, , s/w/d of Insurance
No having been declared as permanently disabled by
the Medical Board/Appeal Tribunal claim permanent disablement benefit
accordingly for the period from to 4
The amount due may be paid to me by money order/in cash at local office.
Date Signature or thumb impression
Present Address
Another Form
I, s/w/d of Insurance No declare that, because of sickness/temporary
disablement, I have not been at work since the date of last/first certificate sent to you.
I no longer claim to be sick/temporarily disabled from
day of 19 and I shall/did not take up any work for
remuneration before that day, I claim benefit accordingly. I desire payment in cash at local office/by money order.
Signature or thumb impression
Date Local office Present Address