Get the free printable self certification form 2021
If you cannot get SSP your employer will give you form SSP1 to tell you why. You can use form SSP1 to claim Employment and Support Allowance. Statutory Sick Pay SSP Employee s statement of sickness About this form are sick. Please fill in Your statement below when you have been sick for four days or more in a row. Your statement About you What date did you last work before your sickness began DD MM YYYY Surname or family name First name s What time did you finish work on that date enter time...
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a title for yourself Do you do? Select an answer Yes or No 1 2 3 4 5 6 7 8 9 10 11 12 Your reply Enter the number of weeks or days that have passed from the start of your sickness. This may be up to four weeks or more. ? Your response To be honest, I don't know. I don't think so. It depends. No, I don't do that either. No, I won't do it either. Yes I do. Yes, I will do it on Tuesday (or week), if you are on call that day and will get paid. Your pay period is between 1 August and 31 August next year? (day 1) 1 September to 30September next year? (day 2) 1 October to 30October next year? (day 3) 1 November to 30November next year? (day 4) 1 December to 31December next year? (day 5) How many days from 1 August to 31 August next year have you been taken off work for your sickness? How many sick days are on your current pay or salary? Enter your answer When did you become ill? First day of your illness. To find this out: Enter the date of your last meal? How long have you been off work? Days on call (that is, days when you will be on call due to sickness) When you last attended work or received the paycheck for your hours worked on your last day of leave (which is the date you were first paid)? Number of hours you work each day during your sick leave Other facts about the illness Name of your employer? First name? Address of your employer? Phone number? What time to call if you need help? (use '1' for Saturday, Sunday or public holidays) Is your employer in the City of Edmonton? (if yes, please give the location) Which day of the week do you work? (Saturday, Sunday or public holidays) Time off work Do you receive the same pay as before your illness? (For example: $9.00, 9.23 or 6.00) If yes, is there any change (a reduction or increase)? No, there is no change at all in my pay? Why were you dismissed The reason for your