_Autrtan Govern ever Antal ae Employment Separation Certificate When to use this form For more information Use this form to provide information when requested by a former employee. We use this information to ‘make sure we pay customers the right amount from the correct date. Complete and return this form tothe former employee or us within 14 days of recelving it This notice is given under either section 196 (f received from Centrelink) or saction 199 (received trom «former employee) of the Social Secunty (Administration) Act 1999-and allows a former employee oF Centrelink to obtain this information. Al the information contained In, or attached to the catificate may be released to any person under the Freedom of information Act 1962. you want any of ths information treated in confidence, please attach a statement indicating which Information, and give your reasons. This will be considered if a request is made Under the Freedom of information Act 1982, Employers have obligations to pay superannuation for elighle employees and some contractors. For more information, go to ato.gov.au or call the Australian Taxation Office on 131 020. Services Australia provides a direct service to employers through its Business Hub. If you have any questions about the Employment Separation Certificate, call the National Business Gateway on 131 158 or fax 192.115, 60 to servicesaustralia.gov.au/sepcertemployers Help in your language ‘To speak to us in your language, call 131 202, Call charges may apply. Telephone Typewriter Ir you have a hearing or speech impairment, you can call the TTY service on 1800 810 586, ATTY phone is required to use this service.Definitions Information for former employees How to get more Employment Separation Certificates Long Service Leave Iv the person was pald long service leave and worked full-time, please make sure you have marked the appropriate box against a 5 or 7 day week in question 7. Average gross weekly wage ‘This fs usually contained in the industrial instrument that applies to that workplace (Including the appropriate award, workplace agreement or common law contract). Some workplaces include regular overtime and allowance as part oftheir average weekly wage. Employment Termination Payments (ETP) COniy certain payments paid to an employee on termination of employment are ETPs. These payments are taxed differently from other kinds of payments made on termination of employment. if you donot have another jb to go to and you want to claim a Centrelink payment you will need to: * go to servicesaustralia.gov.au/jobseekers + cal our employment services lie on 132 850 ‘visit one of our service centres Your claim wil start the date you submit a completed claim form, including all dacuments required. Did you receive a payment for a redundancy, annual leave, long service leave, sick leave or maternity leave? It you dd, there may be a weiting period before you can receive an income support payment. To avoid a situation where you have no access to funds and no access to an income support payment, you should contact us to find out how long your waiting peri will be before you spend your termination payment, You may also have a waiting period depending on the amount of liquid assets (for example, money, shares) you have available ‘You should contact us as soon as possible once you cease employment. To get more Employment Separation Certificates, you can g0 to servicesaustralla.gov.au/forms and print more copies ‘call 1800 067 307 or 131 158 to get more copies ofthis form ‘© provide all the required information in a letter on your company letterhead and fax to 132 115 ‘+ photocopy the Employment Separation Certificate on the next pages and make sure you place your stamp on the photocopy.a fi srt om Employment Separation Certificate (suo0} ‘This document certifies employment information, Please read the information on page 1 before completing this form. Note: Personal information is protected by law and can be given to someone else only in special circumstances, where Commonvveatth legislation requires or where you give permission Giving false or misleading information isa serious offence, ‘completing form by hand: Print clearly using @ black pen only + Use BLOCKLETTERS — « Print one character in each box + Print inal appropriate boxes __—_* Do not use correction ud or tape * Mark boxes [X] 11 Employee details (Former employees please see important 3 Employment detalls information on pago 1 ofthis form) Date emplayee started working for you Family name ‘yen ver H[u]s[s[at[N|t [4] [4]4] [2[o[2[4 Date employment ceased ay ee First given name 2]8] [o[6] (2]0|2]3 4 Reason for separation ‘Address Shortage of work [J a1 TPlelalelul Jelolulrit ‘Unsuitaity for this type of work ] End of season or contract (C] R/A[N]BO[U]R wle|s|r a ! 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