Apply as an Individual

What date do you want to claim MERA from?

Personal Details

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 2nd March 2020
Have you worked and earned a minimum of £200 per week, on average, in 13 of the last 26 weeks?

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) Have you received the £3000 Business Support Grant from the Department for Enterprise’s Business Support Scheme?
(Self-employed only) Did you actually register to be self-employed with The Treasury before 2 March 2020?
(Self-employed only) Have you actually paid Class 2 National Insurance Contributions for at least 13 out of the past 26 weeks?

Previous 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?
How much will you receive?
Payment Period From
Payment Period To

Previous 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?
How much will you receive?
Payment Period From
Payment Period To

Previous 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?
How much will you receive?
Payment Period From
Payment Period To

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 if I am awarded MERA, I cannot make a claim to the Department for Enterprise’s Business Support Scheme
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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