Notice of appeal against a decision of a Claims Officer …

1 Notice of appeal against a decision of a Claims Officer Application in terms of section 37(1) read with regulation 8(1). A person entitled to benefits in terms of the Act may appeal against a decision of a Claims Officer relating to the payment or non-payment of benefits. This Notice of appeal must be sent to: The Regional Appeals Committee OFFICE STAMP. c/o The Office of the Provincial Executive Manager Department of Labour _____. _____. _____. 1. Personal details Name _____. ID number_____. Passport number _____. Residential address _____. Postal address _____. E mail address _____. Tel number (include the code)_____. Cell number _____. 2. Employer details Name of employer (prior to unemployment) _____.

2 UIF reference number _____. Physical address _____. Postal address _____. E mail address _____. Tel number _____. Fax number _____. UI-12. 3. decision appealed against What decision are you appealing against ? _____. Which body made the decision ? _____. When was the decision made? _____. When were you notified about the decision ? _____. Why are you appealing against the decision ? _____. In what respects do you think the decision is incorrect or unfair? _____. _____. _____. What outcome do you seek from this appeal ? _____. _____. _____. Signature Date KINDLY NOTE THAT THE appeal MUST BE LODGED IN WRITING WITHIN 90 DAYS OF. RECEIVING THE REFUSAL/SUSPENSION Notice . 2. UI-12. -3- For official purposes On the_____, the Regional Appeals Committee decided that the appeal was Successful Unsuccessful because_____.

3 Signature of chairperson:_____ Date:_____. 3.