Employment Insurance Report Record and Attestation Submission

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Employment Insurance Report Record and Attestation

Claimant Details

Claimant: THEODORE KATOTIKIDIS

This report covers the period from January 01, 2012 to January 14, 2012.

The following is a record of the questions and the answers that you confirmed and submitted for the reporting period indicated above.

Report Questions and Confirmed Answers

1. Address and Direct Deposit

Have you moved, changed your mailing address, or changed the banking information you provided for Direct Deposit purposes?

Answer: No

2. Outside Canada

Were you outside Canada between Monday and Friday during the period of this report?

Answer: No

3. Work and Wages

Are you self-employed?

Answer: No

Did you work or receive any earnings during the period of this report? This includes work for which you will be paid later, unpaid work, or self-employment (including farming).

Answer: No

4. Training

Did you attend school or a training course during the period of this report?

Answer: No

5. Availability

Were you ready, willing, and capable of working each day, Monday through Friday, during each week of this report?

Answer: Yes

6. Other Money

Is there any other money that you have not previously told us about, that you received or will receive for the period of this report?

Answer: No

Confirmation Statement and Legal Notice

I declare that the answers provided to the questions on the Employment Insurance online report are true to the best of my knowledge.

I understand this information will be used to determine my eligibility for Employment Insurance benefits.

I understand the information I have provided is subject to verification and that giving false information for myself or someone other than myself constitutes fraud. I also understand there are penalties for knowingly making false statements.

At the end of your successful online reporting session, you will be advised of the earliest date you can submit your next report. It is important to file your next report within three weeks of the due date; otherwise, a loss of benefits may occur.

The information you provide in your report is being collected under the authority of, and will be used for the purpose of administering the Employment Insurance Act.

Please note that by providing and submitting your SIN and Access Code, you will be deemed to have signed your online report.

Report Submission Confirmation

Report submitted on: January 13, 2012 14:44:04

This confirms that your report for the period ending Saturday, January 14, 2012 has been successfully received. You do not need to contact us to check that we have received your report.

Next Report Filing Date

You can file your next report on Saturday, January 28, 2012. It is important to file your next report within 3 weeks of this date; otherwise, loss of benefits may occur.