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UI-19D UNEMPLOYMENT INSURANCE ACT 63 OF 2001 Information about employee FAX NO 012 337-1943/1944/1580/1581/1582 Information to be supplied in terms of Section 56 1 3 read with Regulation 13 1 2 An employer must before the seventh day of each month inform the Commissioner of any changes arising during the previous month regarding the employer s contact details or employees remuneration details including new appointments and termination of service. The employer must forward this form to the UIF PRETORIA 0052 or alternatively fax form to any of the above numbers. EMPLOYER DETAILS 1. 1 UIF Employer Reference No Name of Employer 1. 3 Physical address Postal address E-mail address 1. 5 Phone No 2. EMPLOYEE DETAILS 1. 6 Fax No A B Surname Initials C ID Number 13 Digit bar-coded RSA ID No* D Remuneration1 E Frequency Paid2 F Actual Hours Worked3 G H Commencement date as a contributor J Reason for Termination I PM/PW/PD R c M Y I Name of Employer Identity no declare that the above information is true and correct. I understand that it is an offence to make a false statement. EMPLOYER SIGNATURE DATE Frequency Paid ie. M Monthly W Weekly D Daily H Hourly and F Fortnightly Frequency Worked ie. M Monthly W Weekly D Daily H Hourly and F Fortnightly Employers may also submit these details electronically from their payrolls or on the UIF s Website at www. The employer must forward this form to the UIF PRETORIA 0052 or alternatively fax form to any of the above numbers. EMPLOYER DETAILS 1. 1 UIF Employer Reference No Name of Employer 1. 3 Physical address Postal address E-mail address 1. EMPLOYER DETAILS 1. 1 UIF Employer Reference No Name of Employer 1. 3 Physical address Postal address E-mail address 1. 5 Phone No 2. EMPLOYEE DETAILS 1. 6 Fax No A B Surname Initials C ID Number 13 Digit bar-coded RSA ID No* D Remuneration1 E Frequency Paid2 F Actual Hours Worked3 G H Commencement date as a contributor J Reason for Termination I PM/PW/PD R c M Y I Name of Employer Identity no declare that the above information is true and correct. 5 Phone No 2. EMPLOYEE DETAILS 1. 6 Fax No A B Surname Initials C ID Number 13 Digit bar-coded RSA ID No* D Remuneration1 E Frequency Paid2 F Actual Hours Worked3 G H Commencement date as a contributor J Reason for Termination I PM/PW/PD R c M Y I Name of Employer Identity no declare that the above information is true and correct. I understand that it is an offence to make a false statement. EMPLOYER SIGNATURE DATE Frequency Paid ie. I understand that it is an offence to make a false statement. EMPLOYER SIGNATURE DATE Frequency Paid ie. M Monthly W Weekly D Daily H Hourly and F Fortnightly Frequency Worked ie. M Monthly W Weekly D Daily H Hourly and F Fortnightly Employers may also submit these details electronically from their payrolls or on the UIF s Website at www. The employer must forward this form to the UIF PRETORIA 0052 or alternatively fax form to any of the above numbers. EMPLOYER DETAILS 1. 1 UIF Employer Reference No Name of Employer 1. 3 Physical address Postal address E-mail address 1. 5 Phone No 2. EMPLOYEE DETAILS 1. 6 Fax No A B Surname Initials C ID Number 13 Digit bar-coded RSA ID No* D Remuneration1 E Frequency Paid2 F Actual Hours Worked3 G H Commencement date as a contributor J Reason for Termination I PM/PW/PD R c M Y I Name of Employer Identity no declare that the above information is true and correct.