Get Loss Of Earnings Form

Completing the Loss Of Earnings Form online is a crucial step in claiming assistance for lost income due to acts of violence. This guide will provide you with a clear, step-by-step approach to ensure that you fill out the form accurately and comprehensively.

Follow the steps to complete your Loss Of Earnings Form online.

1. Click the ‘Get Form’ button to obtain the Loss Of Earnings Form and open it in your preferred editor.
2. In the application section, provide your reference number and personal details as directed. Make sure to include your name and contact information.
3. For section A, state your weekly gross pre-injury earnings. Utilize the provided examples to explain how you calculated this figure and list the documents you used for verification.
4. In section B, specify the period you were unable to work due to your injury. Fill out the columns with detailed dates, total time off work, and the corresponding amounts from section A.
5. Calculate your total loss of earnings by multiplying your total time off work by the weekly gross pre-injury earnings you've indicated in section A.
6. In section C, list any payments you have received during your absence from work, such as sick pay or social security payments. Be thorough in reporting all sources of income to ensure an accurate claim.
7. Finally, sum the amounts and complete section D to indicate the total amount you are claiming. Review your information for accuracy before proceeding.
8. Once you have filled out the form, save your changes, and download or print the completed form. You may also opt to share it as needed.

Ensure your claim is accurately submitted by filling out the Loss Of Earnings Form online today.