Unemployment insurance fund




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UNEMPLOYMENT INSURANCE FUND

94 Church Street, Pretoria / Postal Address: UIF, Pretoria, 0052 / Tel: (012) 337-1680



APPLICATION FOR REGISTRATION AS AN EMPLOYER

Unemployment Insurance Contributions Act, 2002



Completed form can be posted to the UIF, or faxed to (012) 337-1636 or submitted at any branch of the UIF which is closest to the employer. The form can also be faxed to any of the following numbers: Pta (012) 309 5142/5286;Jhb (011) 497 3293;Dbn (031) 366 2156;Polokwane (015) 290 1670;Mmabatho (018) 384 2658;East Ldn (043) 701 3263;Blftn (051) 447 9353; CT (021) 441 8024;Wtb (013) 656 0233;PE (041) 586 1541;Gmn (011) 873 2219;George (044) 873 2568;Pmb (033) 394 5069;Kimberley (053) 832 7218








Employer information to be Provided:










1.

(a) Date on which the first contributor (employee) was employed or date on which business changed ownership:

..................................................................................................













(b) Number of contributors employed:

............................................







2.

Name under which business is carried on (Trade Name): ...............................................................................................................................................................................................




3.

Ownership Type:




1 = Sole Owner, 2 = Partnership, 3 = Company, 4 = Close Corporation, 5 = Trust, 6 = Other







4.

Nature of business: ..........................................................................................................................................................................................................................................................







5.

In the case of a Co. or CC, the Registered Name ............................................................................................................................... and Number ......................................................







6.

PAYE number if registered with SARS (Not the VAT or Personal Tax Number): ...................................................................................................







7.

Magisterial district in which business is situated:

...............................................................................................

8.

Municipality:

........................................................................




9.

Business telephone and fax numbers: Code:

........................

Phone number:

.................................................

Fax number:

.................................................







10.

Business e-mail address (if applicable): ................................................................................................................

11.

Language preference:




1 = English, 2 = Afrikaans




12.

Business postal address:

.................................................................................................................................................................................

Postal code:

................................













13.

Business street address:

.................................................................................................................................................................................

Postal code:

................................
















14.

Particulars of owner, partners, directors, members, chairperson, secretary, etc.


















Surname and Initials:

...........................................................................................................................

ID No.




















































Postal address:

......................................................................................................................................................................................

Postal code:

................................



















Residential address:

......................................................................................................................................................................................

Postal code:

................................






Surname and Initials:

...........................................................................................................................

ID No.




















































Postal address:

......................................................................................................................................................................................

Postal code:

................................



















Residential address:

......................................................................................................................................................................................

Postal code:

................................






Surname and Initials:

...........................................................................................................................

ID No.




















































Postal address:

......................................................................................................................................................................................

Postal code:

................................



















Residential address:

......................................................................................................................................................................................

Postal code:

................................






N.B.

Where ID number is not applicable, please indicate passport or other identification number.



N.B.

A completed form UI-19 in respect of employees must accompany this form, or please indicate clearly that the information of employees will be submitted electronically.






I hereby declare that all the information furnished on this form, is true and correct.













Date:

......................................................

Signature of employer or authorised agent:

...................................................................................................................................


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