- Government of Bermuda

Bermuda Government Unemployment Benefits Application

Bar, Restaurant, and Club Restrictions and Closures

Ensure you save link to this form https://uba.gov.bm/Form/FormB/c9ab040f-18ef-4376-86a4-585230ffaea8 in case you want to return back to it. DO NOT SHARE THIS LINK WITH ANY ONE AS IT INCLUDES YOUR PERSONAL DATA AND IT IS UNIQUE TO YOU.

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1. Employee Information

Social Insurance Number If you do not have this number on hand, please contact your employer or the Department of Social Insurance at 294-9242.

First Name

Middle Name

Last Name

Date of Birth M/DD/YYYY

Mailing Address

Parish

Postal Code

Home Phone Number

Cell Phone Number

Work Phone Number

Email Address

2. Status

Please select one of the following:

Please refer to section 7 and upload required documents:

Only one of the following documents is required):

Copy of Passport Information Page and Registered Bermudian Stamp
Copy of Voter’s Identification Card

Copy of Official Spousal Letter from the Department of Immigration

Copy of Permanent Resident Certificate

Copy of Official Work Permit Card issued by the Department of Immigration

4. Employer’s/Self-Employment Details

CompanyName

Primary Contact

Employer Contact Number

Company Address

Postal Code

Nature Of Business

Employer Cell Phone Number

Work Phone Number

Email Address Please check for accuracy

4. Employment Status

Job Title

5. Other Benefits

Are you on Financial Assistance or Supplementary Unemployment Benefit?:

Have you received unemployment benefits during COVID-19?

6. Banking Information

Bank Name

Account Type

Account Holder Name

Account Number (no spaces)
Note: You need to select bank name first.

*The applicant must be listed as an account holder on the account provided. The bank account details should match the account ordinarily used for payroll.

Have you worked previously for Government or a Quango

I authorize Government of Bermuda to verify the information provided on this form (1) to confirm my identity (2) to augment and update currently held information; (3) to provide me with accurate payment; (4) to satisfy information requests; and (5) to meet legal and regulatory requirements.

7. Required Supporting Documents

Please upload the following documentation to support your application. Failure to provide the information requested may result in significant processing delays and/or denial of your application.

SECTION 1 PHOTO IDENTIFICATION DOCUMENT

Copy of photo identification document

Copy of photo identification document

Copy of photo identification document

Copy of photo identification document

SECTION 2 VERIFICATION OF BANKING DETAILS (Upload file)

Copy of bank account statement to verify name, address and account number.

TERMS OF AGREEMENT

I certify that the information in this application is true and correct to the best of my knowledge. I confirm that I am not receiving Financial Assistance benefits. I understand the information requirements, conditions and terms of this benefit and agree to provide any supporting documentation that the Government of Bermuda may require. I understand that if I knowingly provide untrue, false, misleading or inaccurate information then I will be ineligible for the unemployment benefit, any benefit granted to me may be reversed, and I will be responsible for any and all repayment and may be subject to prosecution. I agree to provide my personal information in order for the Department of Workforce Development to determine my eligibility for an unemployment benefit to provide Covid-19 relief. I understand that the information shared will only be used for the purpose stated above.