Apply as an Individual

What date do you want to claim MERA from?

Personal Details

Full Name
Date of Birth
National insurance Number
Telephone
Email
Isle of Man Resident and have been ordinarily resident in 13 of the last 26 weeks?
Are you currently present on the Isle of Man?

Address

Banking Details

Benefit details

Are you or your partner currently claiming any benefits other than Child Benefit?
If yes, have you or your partner claimed Income Support, Income based Jobseeker’s Allowance, or Employed Person’s Allowance?
If yes, have you claimed Incapacity Benefit or contribution based JSA?
If you answered yes to any of the above 3 questions, please list the benefits you and/or your partner are receiving and the name each claim is in.

Employment

Are you available and capable of work?
Employment Status prior to 3 March 2021
Have you worked and earned a minimum of £200 per week, on average, in 13 of the last 26 weeks immediately before the date of your claim?

Self Employment (if applicable)

(Self-employed only) Nature of Self Employment
(Optional for self-employed) If applicable, provide your Registered Business Name
Date Last Worked
(Self-employed only) Did you actually register to be self-employed with The Treasury before 4 January 2021?
(Self-employed only) Have you actually paid Class 2 National Insurance Contributions for at least 13 out of the past 26 weeks immediately before the date of your claim?

Employment 1

Employer Name (if self-employed, please provide name of business (if applicable) or write ‘self’)
Pay
Per
Last Date Worked
Will you receive any further pay?
What date will you receive this pay?
How much will you receive?
Payment Period From
Payment Period To

Employment 2

Employer Name (if self-employed, please provide name of business (if applicable) or write ‘self’)
Pay
Per
Last Date Worked
Will you receive any further pay?
What date will you receive this pay?
How much will you receive?
Payment Period From
Payment Period To

Employment 3

Employer Name (if self-employed, please provide name of business (if applicable) or write ‘self’)
Pay
Per
Last Date Worked
Will you receive any further pay?
What date will you receive this pay?
How much will you receive?
Payment Period From
Payment Period To

I confirm I am not in receipt of any income from employment or self employment over £50 a week

Declaration

I confirm that the information I have given on this form is true and complete.
I understand that if I earn more than £50 in any week I will not be entitled to MERA for that week.
I understand that I must advise Social Security straightaway if I start working and earn more than £50 per week in any week or if my employer pays me any remuneration whilst I’m claiming MERA.
I understand that if I provide false or inaccurate information or fail to report a relevant change in my circumstances legal action (which may include prosecution) may be taken against me and I will have to repay any money I’m not entitled to.
I understand that the Social Security Division may share and request information and personal data relating to my claim for MERA with other parts of Government in order to verify my entitlement to MERA and other government schemes.
This is my claim for Manx Earnings Replacement Allowance (MERA).

I confirm the above to be true and correct

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