Fill in Unemployment / Sole-Earner Affidavit

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Unemployment / Sole-Earner Affidavit

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UNEMPLOYMENT / SOLE-EARNER AFFIDAVIT

I, __________, __________, resident of __________, holding __________, ordinarily resident within __________ (the "Deponent" or "I"), do hereby solemnly affirm and declare as follows:

1. MY POSITION

2. PURPOSE

2.2 I undertake to inform the person or office to whom this affidavit is given if my position stated above changes before it is acted upon, and I understand that any benefit granted on the strength of a false statement here may be withdrawn.

3. DECLARATION

3.1 Every statement made above is true to my own knowledge and belief, and I have concealed nothing material to this application. I am aware that making a false declaration in an affidavit is an offence.

VERIFICATION

DEPONENT

Signature: ______________________________
__________

ATTESTATION

Notary Public / Oath Commissioner
Registration No. and seal: ____________________

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