Claim for Unemployment Assistance BenefitThe Employer / Self Employed person should complete this Application Form for each month, listing the names of the persons eligible for the benefit. Employer Registration Number*Employer Registration SubBusiness Name/ Self-Employed Name*In receipt of Government Payroll SupportNoYesName of Authorized Officer*Telephone No.*Email Date Date Format: YYYY slash MM slash DD Employee Information Employee NIS no. First Name Telephone no. EmailActions EditDelete There are no Employees. Add Employee Maximum number of employees reached.Consent* I certify that the information above is correct.Warning: Any person who knowingly makes any false statement or false representation for the purpose of obtaining a benefit commits a criminal offence punishable by fine or imprisonment or both.CAPTCHA PROTECTED
