 <p class="MsoNormal" style="text-align: justify"> <span style="font-family: Arial">
IN exercise of the powers conferred on the Commissioner  responsible for Finance by section 29 of the Social Security Act, 
1965 (Act 279) these Regulations 
are made this 8th day of September, 1972.</span></p><p class="MsoNormal" style="text-align: justify">
<b><span style="font-family: Arial">Regulation 1&#8212;Unemployment Benefit.</span></b></p>
<p class="MsoNormal" style="text-align: justify">
<span style="font-family: Arial">(1) Subject to the other provisions of these Regulations, 
unemployment benefit shall be payable to a worker who is a                                               
member of the Social Security Fund and who becomes unemployed.</span></p>                                              
<p class="MsoNormal" style="text-align: justify">  <span style="font-family: Arial">
(2) Unemployment benefit shall be payable for a period not exceeding two months 
commencing from the end of the first month of unemployment.</span></p>
<p class="MsoNormal" style="text-align: justify"><span style="font-family: Arial">
(3) An application for the first unemployment benefit shall be made at the end of the second month of 
unemployment and shall be made on Form SS. 106 specified in the 
First Schedule to these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              (4)&nbsp; The application shall be 
                                              addressed to the Chief 
                                              Administrator&nbsp; accompanied by&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) certificates from the last 
                                              recorded employer of the applicant 
                                              and the Public Employment Centre 
                                              respectively in the forms 
                                              specified in the Second Schedule 
                                              to these Regulations, and</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (b) any other documents or 
                                              information which the Chief 
                                              Administrator may by writing 
                                              require, in connection with the 
                                              application for the benefit.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (5) The application for a further 
                                              unemployment benefit, which shall 
                                              be made at the end of the third 
                                              month of unemployment shall be 
                                              made on Form SS. 107 specified in 
                                              the Third Schedule to these 
                                              Regulations, and shall be 
                                              accompanied by a certificate from 
                                              the Public Employment Centre in 
                                              the form specified in the same 
                                              Schedule, together with any other 
                                              documents or information which the 
                                              Chief Administrator may by writing 
                                              require in connection with the 
                                              said application.&nbsp;&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">

                                              Regulation 2&#8212; Qualification for 
                                              Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">A 
                                              worker shall not be qualified to 
                                              claim unemployment benefit under 
                                              these Regulations, unless&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (a) he becomes unemployed on or 
                                              after the last day of&nbsp; October, 
                                              1972;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) where he has not claimed 
                                              before, he has made not less than 
                                              thirty-six monthly contributions 
                                              to the Fund, at least two of which 
                                              shall have been made within four 
                                              months immediately prior to his 
                                              unemployment; or since he last 
                                              claimed unemployment benefit, he 
                                              has made not less than twenty-four 
                                              monthly contributions, at least 
                                              two of which shall have been made 
                                              within four months immediately 
                                              prior to his unemployment, and
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) he has remained unemployed for 
                                              a period of not less than two 
                                              months or not less than three 
                                              months, as the case may be, 
                                              although he has registered with a 
                                              Public Employment Centre and has 
                                              applied regularly for employment 
                                              in accordance with the directions 
                                              of the Public Employment Centre.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>

                                              <span style="font-family: Arial">
                                              Regulation 3&#8212;Disentitlement to 
                                              Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) A worker shall not be entitled 
                                              to claim unemployment benefit 
                                              under these Regulations, if&#8212;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (a) he is engaged in remunerative 
                                              work of any kind, other than 
                                              part-time employment;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (b) he is laid off as a result of 
                                              labour dispute;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (c) it is certified by the Public 
                                              Employment Centre that he has 
                                              refused to take up any suitable 
                                              employment offered to him; so 
                                              however that an employment shall 
                                              be deemed not to be suitable&#8212;</span></p>

                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">(i) 
                                              if the rate of remuneration in 
                                              relation thereto is lower or the 
                                              other conditions are less 
                                              favourable than those applicable 
                                              to that kind of employment in the 
                                              area in which the employment is 
                                              offered;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (ii) if it would entail residence 
                                              in an area in which accommodation 
                                              appropriate to the circumstances 
                                              of the particular worker is not 
                                              available;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (iii)&nbsp; if it is available in 
                                              consequence of a stoppage of work 
                                              due to labour dispute; or </span>

                                              </p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 72.0pt">
                                              <span style="font-family: Arial">
                                              (iv) if having regard to all the 
                                              circumstances, its refusal by the 
                                              worker is not unreasonable;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (d) he voluntarily vacates his 
                                              employment;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">

                                              <span style="font-family: Arial">
                                              (e) he draws any benefit under the 
                                              Fund other than survivor&#8217;s 
                                              benefit;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">
                                              (f) he receives a redundancy or 
                                              severance pay or both, in 
                                              connection with his present loss 
                                              of employment; or</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 36.0pt">
                                              <span style="font-family: Arial">

                                              (g) he ceases to be a member of&nbsp; 
                                              the Fund.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) For the purposes of paragraph 
                                              (a) of sub-regulation (1) of this 
                                              regulation, &#8220;part-time employment&#8221; 
                                              means an employment in which the 
                                              number of working hours in a week 
                                              does not exceed in aggregate two 
                                              working days and the remuneration 
                                              therefrom appears to the Chief 
                                              Administrator to be substantially 
                                              less than the worker&#8217;s average 
                                              weekly pay assessed in accordance 
                                              with regulation 4 of these 
                                              Regulations. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 4&#8212;Amount of Benefit.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) The amount of the unemployment 
                                              benefit shall be computed on the 
                                              basis of the average monthly pay 
                                              of the worker over the twelve 
                                              months immediately preceding his 
                                              unemployment, and the amount of 
                                              the first unemployment benefit 
                                              shall be equivalent to fifty per 
                                              centum of such average monthly pay 
                                              of the worker.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (2) If the period of unemployment 
                                              exceeds three months, the worker 
                                              is entitled to claim a further 
                                              unemployment benefit, at the end 
                                              of the third month of 
                                              unemployment, equivalent to 
                                              fifteen cedis or twenty per centum 
                                              of such average monthly pay of the 
                                              worker, whichever is higher.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 5&#8212;Unemployment Benefit 
                                              Fund.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (1) There shall be a Fund to be 
                                              known as the Unemployment Benefit 
                                              Fund, to which the Chief 
                                              Administrator shall, with effect 
                                              from 1st July, 1972, transfer 
                                              monthly an amount equivalent to 
                                              one per centum of the worker&#8217;s pay 
                                              from the employer&#8217;s Social 
                                              Security contribution of twelve 
                                              and a half per centum.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2)&nbsp; The unemployment benefit 
                                              shall be a change on the said 
                                              Fund.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 6&#8212;Offence.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Any person who, for the 
                                              purposes of claiming any 
                                              unemployment benefit under these 
                                              Regulations knowingly makes any 
                                              false statement or representation, 
                                              or produces or furnishes, or 
                                              causes to be produced or 
                                              furnished, any document or 
                                              information which he knows to be 
                                              false in a material particular 
                                              commits an offence punishable 
                                              under the Social Security Act, 
                                              1965 (Act 279).</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              (2) Any person appointed or acting 
                                              as employee under the Social 
                                              Security Act, 1965 (Act 279), who 
                                              conspires with or aids and abets 
                                              any other person in the commission 
                                              of any offence under 
                                              sub-regulation (1) of this 
                                              regulation is guilty of an offence 
                                              punishable under the said Act.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 7&#8212;These Regulations to 
                                              be Read as One with L.I. 470.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              These Regulations shall be read as 
                                              one with the Social Security 
                                              Regulations, 1965 (L.I. 470) and 
                                              the said Social Security 
                                              Regulations shall have effect 
                                              subject to such modifications as 
                                              may be necessary to give effect to 
                                              the provisions of these 
                                              Regulations.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <b>
                                              <span style="font-family: Arial">
                                              Regulation 8&#8212;Commencement.</span></b></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              These Regulations shall be deemed 
                                              to have come into force on 1st day 
                                              of July, 1972.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>
                                              <span style="font-family: Arial">
                                              SCHEDULES</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>

                                              <span style="font-family: Arial">
                                              FIRST SCHEDULE</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Form SS. 106</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              REPUBLIC OF GHANA</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SOCIAL SECURITY ACT, 1965 (ACT 
                                              279)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              The Chief Administrator,</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Social Security Fund,</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              P.O. Box M. 149,</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Accra.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICATION FOR FIRST UNEMPLOYMENT 
                                              BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Important</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (1) Any person who makes a false 
                                              statement or representation or 
                                              produces or furnishes or causes to 
                                              be produced or furnished any 
                                              information which he knows to be 
                                              false in a material particular is 
                                              guilty of an offence under the 
                                              Social Security Act, 1965. </span>
                                              </p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              (2) A certified statement of 
                                              additional contributions made by 
                                              you since the last Annual 
                                              Statement of Account must be 
                                              attached to this application.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              APPLICANT&#8217;S 
                                              LABOUR&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              APPLICANT&#8217;S SOCIAL SECURITY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CARD 
                                              NO.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              REGISTRATION NO.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              as on Certificate of Membership</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; {&nbsp; Full 
                                              Name&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.............&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Surname First)</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              of&nbsp; Member&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
 {&nbsp;&nbsp; Son/Daughter 
                                              of &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..........</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &nbsp;{&nbsp;&nbsp; Date of 
                                              Birth&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;............</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              hereby apply for First 
                                              Unemployment Benefit. I have made 
                                              36/24* 1 monthly contributions to 
                                              the Social Security Scheme since 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;..(date) when * I joined 
                                              the Scheme/* I last claimed 
                                              benefit.&nbsp; I was laid off on&#8230;&#8230;&#8230;&#8230;&#8230;. 
                                              2 due to 
                                              *redundancy/closure/sickness/labour 
                                              dispute/voluntary vacation of 
                                              office/other cause.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Name and address of last 
                                              employer&#8230;&#8230;&#8230;&#8230;.................
..............................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....................................................................&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              He employed me from 
                                              &#8230;............................&#8230;&#8230;.to 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..Previously I worked 
                                              with 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..
from&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;to&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.(N.B. 
                                              Furnish full names and addresses 
                                              of&nbsp; your employers during the 
                                              preceding 36 months.)* I am not 
                                              engaged in any remunerative work.&nbsp; 
                                              * I receive only ¢&#8230;&#8230;&#8230;&#8230;&#8230;.per month 
                                              at &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..(give full address of 
                                              present place of work).</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              *I have registered for work at 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;Public Employment 
                                              Centre, but have not yet got any 
                                              employment.&nbsp; The instrument of 
                                              payment may be mailed to me at the 
                                              following address:&#8212; 
                                              &#8230;&#8230;&#8230;&#8230;................
............................&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...................
..............................................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              certify that I do not hold another 
                                              Certificate of Membership apart 
                                              from the 
                                              following:&#8212;&#8230;&#8230;&#8230;......&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...................
..................................................................................
....................................................................................
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....................&#8230;
&#8230;........................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Witness to&nbsp; Mark</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;........................&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;.............................&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp; 
                                              ................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Address&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp; 
                                              Signature of Claimant</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;.......................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;.......................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Signature and a clear&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              impression of thumbprint are 
                                              required.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
 &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;THUMBPRINT</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ___________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              *Delete whichever is inapplicable.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              SECOND SCHEDULE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CERTIFICATE OF LAST EMPLOYER</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Name and Address of 
                                              Employer&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;.................................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.............
.........................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              CERTIFY that 
                                              Mr./Mrs./Miss&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;............................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 
                                              ......................................... 
                                              (Name of worker) was laid off on 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 
as a result of 
                                              redundancy/closure/labour 
                                              dispute/other cause*.&nbsp; He left/did 
                                              not* leave voluntarily.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              have notified the Public 
                                              Employment Centre at &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;on 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..(date) I have/have not * 
                                              paid him severance/redundancy pay 
                                              amounting to ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;He shall 
                                              be recalled to work on&#8230;&#8230;&#8230;&#8230;&#8230;...</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;* His pay rate3 was 
                                              ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..per month. I made the 
                                              last payment of Social Security 
                                              contributions to the Fund 
                                              on&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
I still owe ¢&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              forward, herewith, a statement 
                                              signed by me, showing the worker&#8217;s 
                                              and employer&#8217;s shares of 
                                              contributions in respect of the 
                                              claimant since the last annual 
                                              statement of account. The claimant 
                                              has been in my employ from 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.to &#8230;&#8230;
&#8230;&#8230;&#8230;.He has been 
                                              given another job 
                                              as&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;at &#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              on&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230; .&#8230; but he has turned 
                                              it down.&nbsp; </span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              ........&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
......................................................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>
                                              <span style="font-family: Arial">
                                              Signature of officer authorised to 
                                              sign cheques for Social Security 
                                              Fund.</span></i></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              EMPLOYER&#8217;S SOCIAL SECURITY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; REGISTRATION NUMBER</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;................................
.................................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>
                                              <span style="font-family: Arial">

                                              Signature of Managing Director or 
                                              Manager or Head of Establishment
                                              </span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CERTIFICATE OF OFFICER IN CHARGE 
                                              OF PUBLIC EMPLOYMENT CENTRE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              CERTIFY that Mr./Mrs./Miss 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;.. SS. No&#8230;&#8230;&#8230;&#8230;.. Labour 
                                              Card No. ..........&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. 
                                              has registered for employment 
                                              at&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.but has been directed 
                                              on any employer as yet.&nbsp; He/she 
                                              has refused to take up suitable 
                                              employment 
                                              as&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;at&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..on&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              Full Name of 
                                              Officer&#8230;&#8230;&#8230;........................
............&#8230;&#8230;&#8230;&#8230;&#8230;.&nbsp;&nbsp;&nbsp; 
                                              Signature&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..........................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Rank&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;.&#8230;&#8230;....................&#8230;&#8230;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Station&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;........................&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Date&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.....................&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              _________________</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;Note*&nbsp; (1)&nbsp; Delete whichever is 
                                              inapplicable.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (2) Benefit will only 
                                              be considered in respect of 
                                              unemployment occurring after 1st 
                                              October. 1972.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; (3) Only payrate on 
                                              which contribution was made over 
                                              the last 12 months may be given.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <i>
                                              <span style="font-family: Arial">
                                              THIRD SCHEDULE</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <i>
                                              <span style="font-family: Arial">
                                              FORM SS. 107</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICATION FOR SECOND 
                                              UNEMPLOYMENT BENEFIT</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">A 
                                              certified statement of additional 
                                              contributions made by you since 
                                              the last Annual Statement of 
                                              Account must be attached to this 
                                              application.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              APPLICANT&#8217;S 
                                              LABOUR&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              APPLICANT&#8217;S SOCIAL SECURITY</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              CARD NO.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;REGISTRATION 
                                              NO.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Particulars&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; { Full 
                                              Name&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.......
.................................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              of&nbsp; Member&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              {&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
                                              (Surname First)</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{ 
                                              Son/Daughter of 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
.....................................................&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;{ Date 
                                              of 
                                              Birth&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;...........................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              hereby apply for Second 
                                              Unemployment Benefit.&nbsp; I was paid 
                                              the first benefit of 
                                              ¢&#8230;&#8230;......................&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 
                                              on &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; at&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              have not as yet succeeded in 
                                              getting a job, although I have 
                                              been making serious efforts and 
                                              have called at the Public 
                                              Employment Centre several times.&nbsp; 
                                              I understand that I shall not be 
                                              entitled to a further Unemployment 
                                              Benefit unless I returned to work 
                                              and made a minimum of 24 further 
                                              contributions to the Unemployment 
                                              Fund.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Witness to Mark:</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              &#8230;&#8230;&#8230;&#8230;&#8230;.........&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature and Thumbprint of 
                                              Claimant&nbsp; </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Address&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.. </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              CERTIFICATE OF OFFICER IN CHARGE 
                                              OF PUBLIC EMPLOYMENT CENTRE</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">I 
                                              CERTIFY THAT 
                                              Mr./Mrs./Miss&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..................................&#8230;&#8230;&#8230;
&#8230;&#8230;...........................&#8230;&#8230;&#8230; 
                                              SS. No. 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....................... 
                                              Labour Card No&#8230;&#8230;&#8230;&#8230;
&#8230;.......&#8230;&#8230;&#8230;&#8230;&#8230;&#8230; 
                                              has been registered for employment 
                                              since&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              He/she has not yet succeeded in 
                                              getting any*&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;............&#8230;&#8230;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              He/she has refused to take up 
                                              suitable employment 
                                              as&#8230;&#8230;.......................... at 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;on 
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;...</span></p>

                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Full Name of 
                                              Officer&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;............................................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Signature 
                                              &#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;..............................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Rank&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.........................
.......................................</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">
                                              Station&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;
&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;....</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">

                                              _______________ </span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp; 
                                              *Delete whichever is inapplicable.</span></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 216.0pt">
                                              <span style="font-family: Arial">

                                              COLONEL I. K. ACHEAMPONG</span></p>
                                              <p class="MsoNormal" style="text-align: justify; margin-left: 216.0pt">
                                              <i>
                                              <span style="font-family: Arial">
                                              Commissioner Responsible for 
                                              Finance</span></i></p>
                                              <p class="MsoNormal" style="text-align: justify">
                                              <span style="font-family: Arial">&nbsp;</span></p>
                                              <p class="MsoNormal" style="text-align: justify">

                                              <span style="font-family: Arial">
                                              Date of Gazette Notification: 15th 
                                              September, 1972.</span></p>