Employee's statement of sickness to claim Statutory Sick Pay (SC2)
Personal details
Name:
*
Date of birth:
*
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Day
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Month
Year
Date
National Insurance number:
*
Mobile number:
*
Sickness details
Brief details:
*
Date sickness started:
*
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Day
-
Month
Year
Date
Was this sickness caused by an accident at work or industrial disease?:
*
Expected duration of illness/injury:
*
Treatment details:
*
Details of any restrictions on ability to work:
*
Employment details
Last working day before sickness began:
*
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Day
-
Month
Year
Date
Finishing time on day sickness started:
*
Signed
*
Date
*
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Month
-
Day
Year
Date
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