S.I. No. 581/2001 - Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 2001.

(1)These Regulations may be cited as the Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 2001.

(2)These Regulations shall come into operation on 1 January,

2. In these Regulations - “the Act” means the Protection of Employees (Employers' Insolvency) Act, 1984 (No. 21 of 1984); “Principal Regulations” means the Protection of Employees (Employers' Insolvency) (Forms and Procedure) Regulations, 1984 ( S.I. No. 356 of 1984 ); and “Regulations of 1991” means the Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 1991 ( S.I. No. 349 of 1991 ).
3. The Principal Regulations (as amended by the Regulations of 1991) are amended by - (a) The substitution for Regulation

(3)of the following Regulation as Regulation

(3): “3.

(1)The following forms are prescribed as the forms to be used as regards applications under section 6 of the Act: (

1. a)in the case of an application for payment in respect of the period of minimum notice specified under section 4 of the Minimum Notice and Terms of Employment Act, 1973 (No. 4 of 1973), the form (Form EIP 2) set out in Part 2 of the Schedule to these Regulations; and (
2. b)in the case of an application for payment in respect of any other case to which section 6 of the Act applies, the form (Form EIP 1) set out in Part 1 of the Schedule to these Regulations.”, (
3. b)the substitution in Regulation 4(b)(
4. ii)of “the Secretary General, Department of Enterprise, Trade and Employment, Davitt House, 65A Adelaide Road, Dublin 2.” for “the Secretary, Department of Labour, Davitt House, 65A Adelaide Road, Dublin 2.”, (
5. c)by the substitution for paragraph

(2)of Regulation 5 of the following paragraph: “

(2)A statement required by paragraph

(1)of this Regulation shall be made by means of the form (Form EIP 3) set out in Part 3 of the Schedule to these Regulations.”, (

1. d)The insertion after Regulation 6 of the following as Regulation 7: “7. A person shall be deemed to have complied with any requirements under these Regulations to make an application or to prepare a statement in a form prescribed by these Regulations where the application or statement, as case may be, is made in a form to like effect to the prescribed form concerned.”, and (
2. e)The substitution of the matter in the Schedule to these Regulations for the matter in the Schedule to the Principal Regulations. SCHEDULE Part 1 Form EIP1 Department of Enterprise, Trade and Employment EMPLOYEE'S APPLICATION FOR PAYMENT(S) UNDER THE INSOLVENCY PAYMENTS SCHEME An Roinn Fiontar, Trádála agus Fostaíochta Department of Enterprise, Trade and Employment Insolvency Payments Scheme Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 Part 1 Your Details (Please complete in Block Capitals) Figures Letters Employee's PPS no. (formerly RSI no.) Employee's Surname Employee's First name Employees Address Date of Birth Day Mth Yr Class of Insurance Please attach copy of P45 if available Part 2 Employer Details Name of Employer Employer's full address Business Is your employer formally insolvent? (i.e. in Liquidation, Receivership etc) Name of Receiver/ Liquidator/ Employer Representative Telephone no. Part 3 Employment Details Occupation Date of Commencement of employment Day Mth Yr Date of Termination of employment Day Mth Yr Gross Weekly Pay € Wk Mth No of days and hours normally worked per week Days Hours Director Secretary Shareholder Were you a Director/Secretary or Shareholder of the Company. (please tick as appropriate) Part 4 Arrears of Wages Are you owed any wages? Yes No Tick the Yes Box if you are owed wages, overtime, bonus or commission payments and give details in the spaces provided. If wages claim include bounced cheques please attach bounced cheque. In relation to overtime, bonus and commission, please see note 6. Type From To No. of weeks/days Gross weekly wage Amount Due (wages bonus etc) Day Mth Year Day Mth Year (Actual) € € € € € € € € Average (if required) See note 6 € Total Arrears of Wages Claimed € Deductions from wages : i.e Union Dues, V.H.I., etc. Type From To No. of weeks Gross weekly wage Amount Due Day Mth Year Day Mth Year € € € € € € € € Total Arrears of Deductions Claimed € Part 5 Arrears of Holiday Pay From To Total no. of weeks due Day Mth Year Day Mth Year (incl. Any public hols. due) Annual Leave Entitlement No. of days Annual Leave Taken No. of days Public Holidays Due No. of days Gross Weekly Pay € Arrears of Holiday Pay Claimed € Part 6 Arrears due under a Company Sick Pay Scheme From To Total no. of weeks due Day Mth Year Day Mth Year (incl. Any public hols. due) Weekly amount of Social Welfare Benefit € Total Amount of Social Welfare Benefit payable during the period € Weekly payment by Employer under Sick Pay Scheme (Exclusive of Social Welfare payments) € Gross Weekly Pay € Total Arrears of Sick Pay Claimed € Part 7 Anti-Discrimination (Pay) Act, 1974 or Employment Equality Act, 1977 Anti Discrimination(Pay) Act, 1974 Employment Equality Act, 1977 (please tick as appropriate) Date Amount Reference No. Has an appeal been Day Mth Year lodged Y/N Equality Officer Recommendation € Labour Court Determination € Civil Court award € Labour/ Civil Court Compensation € High Court Judgement € Note: Please attach copy of recommendation, determination, decision, award or judgement as appropriate. Date refers to date of recommendation, determination, decision, etc Part 8 Unfair Dismissals Act, 1977 or Court Awards in respect of Unfair or Wrongful Dismissal Date Amount Reference No. Has an appeal been Day Mth Year lodged Y/N Rights Commissioner Recommendation € Employment Appeals Tribunal Determination € Circuit Court Order € High Court Judgement € Note: Please attach copy of recommendation, determination, order or judgement as appropriate. Date refers to date of recommendation, determination, order, etc. Part 9 Maternity Protection Act, 1994 , Adoptive Leave Act, 1995 or Parental Leave Act, 1998 Maternity Protection Act, 1994 Adoptive Leave Act, 1995 Parental Leave Act, 1998 (please tick as appropriate) Date Amount Reference No. Has an appeal been Day Mth Year lodged Y/N Rights Commissioner Recommendation € Employment Appeals Tribunal Determination € Circuit Court Order € Note: Please attach copy of recommendation, determination, or order as appropriate. Date refers to date of recommendation, determination, order, etc. Part 10 National Minimum Wage Act 2000 Date Amount Reference No. Has an appeal been Day Mth Year lodged Y/N Rights Commissioner Decision € Labour Court Determination € High Court Judgement € Note: Please attach copy of decision, determination or judgement as appropriate. Date refers to date of decision, determination, judgement, etc. Part 11 Statutory Minimum Wages under an Employment Regulation Order Note: A claim under this part is not payable unless proceedings against the employer under section 45

(1)of the Industrial Relations Act, 1946 , for the amount involved have been instituted. Title of Employment Regulation Order Have proceedings been instituted against the employer (Please tick appropriate box) YES NO If Yes, by whom In which Court (if applicable) State the period in respect of which the claim is being made From To Day Mth Year Day Mth Year Total No. of Weeks Gross Weekly pay € Total Claimed € I apply for payment due to me under the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 and declare that I have made no other applications in respect of the amounts shown above. I am aware that my rights and remedies against my employer in respect of these amounts will be transferred to the Minister for Enterprise, Trade and Employment when payment has been made. I also declare in respect of the amounts claimed above that I have made no appeal in respect of these amounts and I am not aware, to the best of my knowledge that these amounts are the subject of appeal by someone else. Signature:______________________________________ Date:_________________________ WARNING: LEGAL PROCEEDINGS MAY BE TAKEN AGAINST ANYONE MAKING A FALSE STATEMENT ON THIS FORM Part 2 Form EIP2 Department of Enterprise, Trade and Employment INSOLVENCY PAYMENTS SCHEME Protection of Employees (Employers' Insolvency) Acts 1984 to 2001 EMPLOYEE'S APPLICATION FOR PAYMENT OF AN AWARD UNDER THE MINIMUM NOTICE AND TERMS OF EMPLOYMENT ACT, 1973 PART 1 COMPLETE THIS FORM IN BLOCK CAPITALS Employee's Surname: Employee's PPS No. (Formerly R.S.I No.) Employee's Figures Letters First Name: Address of Employee _______________________________________ Business name and address of insolvent Employer:- _______________________________________ _______________________________________ _______________________________________ _______________________________________ Occupation Date of Termination of Employment _______________________________________ _______________________________________ Day Month Year Address of place of employment PART 2: AWARD BY THE EMPLOYMENT APPEALS TRIBUNAL UNDER SECTION 12 OF THE MINIMUM NOTICE AND TERMS OF EMPLOYMENT ACT, 1973 Day Month Year Date of Employment Appeals Tribunal Award_________________________________ Reference number of award_______________________________________________ Gross weekly Wage__________________________________________________________ € Total Amount Claimed/due____________________________________________________ € PLEASE ATTACH A COPY OF THE TRIBUNAL AWARD I apply for payment due to me under the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 and declare that I have made no other applications in respect of the amount shown above. I am aware that my rights and remedies against my employer in respect of this amount will be transferred to the Minister under the Protection of Employees (Employers' Insolvency) Act, 1984 . Signature________________________________ Date__________________ WARNING: Legal proceedings may be taken against anyone making a false statement on this Form. WHEN COMPLETED PLEASE RETURN FORM TO LIQUIDATOR/RECEIVER Part 3 Form EIP3 Department of Enterprise, Trade and Employment Insolvency Payments Scheme Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 APPLICATION BY A RELEVANT OFFICER FOR FUNDS IN RESPECT OF: WAGES, HOLIDAY PAY, SICK PAY, MINIMUM NOTICE AWARDS, ENTITLEMENTS UNDER THE ANTI-DISCRIMINATION (PAY) ACT, 1974 , EMPLOYMENT EQUALITY ACT, 1977 , UNFAIR DISMISSALS ACT, 1977 , COURT AWARDS IN RESPECT OF UNFAIR OR WRONGFUL DISMISSAL, MATERNITY PROTECTION ACT, 1994 , ADOPTIVE LEAVE ACT, 1995 , PARENTAL LEAVE ACT, 1998 , NATIONAL MINIMUM WAGE ACT, 2000 AND STATUTORY MINIMUM WAGES UNDER AN EMPLOYMENT REGULATION ORDER. IMPORTANT: PLEASE READ NOTES BELOW BEFORE COMPLETING THIS FORM 1. When making an initial claim to the Insolvency Payments Section on behalf of the former employees of an Insolvent Company, copies of the following documentation must be attached: (a) Notice of appointment of Liquidator/Receiver (b) Statement of Affairs/Accounts 2. Initial claims for each employee should be accompanied by a copy of the employee's P45 or written confirmation of his/her class of insurance. 3. PLEASE NOTE THAT FAILURE TO COMPLETE THE FORM FULLY MAY RESULT IN DELAY IN MAKING THE PAYMENT. DETAILS OF INSOLVENT COMPANY Employer's PAYE Registered Number Figures Letter Name of company Business Address Nature of Business Names of Directors/Company Secretary PPS No. (Formerly RSI No.) % Figures Letters Shareholding Date of Insolvency day Mth Year Type of Insolvency RELEVANT OFFICER CERTIFICATE Name of Relevant Officer Name of Company Business Address Phone No. Relevant Office Tax No. Figures Letter Please attach a schedule of employee entitlements, Annex EIP3(a) attached shows the format required. Please ensure that your schedule is clearly headed by the company name and PAYE No. You may use the attached example if you wish. How many pages of Annex EIP3(a) are attached? Declaration To: Minister for Enterprise, Trade and Employment In connection with the provisions of the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001, I have accepted, based on the best information available to me, the entitlement of the employees as shown on the attached schedule. No other application has been made by me in respect of these entitlements. I understand that it may be necessary for you to refer information on the entitlements to the Revenue Commissioners and/or to other Government Departments. I hereby give my consent to the disclosure of such information as is in my possession. I also agree to make available to you such records as may be required for examination. I undertake to distribute the appropriate amounts to the employees concerned from the funds received pursuant to this application. Copies of employee claims on the relevant forms are attached. I declare that the company is insolvent and that there are no funds available from which the entitlements claimed on the attached schedule can be paid. The Instrument of payment should be drawn in favour of (Relevant Officer) Address Signature of Relevant Officer Date Department of Enterprise, Trade and Employment Tel:

(01)6312121 Davitt House Fax:

(01)6313273 65a Adelaide Road Web: www.entemp.ie Dublin 2 Lo-call 1890 220222 Schedule of Employee Entitlements Form EIP3 Company Name PAYE No. Annex (

1. a)Employee's Name PPS No. (Formerly RSI NO. Total Arrears of Wages Deductions for union dues, V.H.I. etc. Total Arrears of Holiday Pay Total Arrears of Sick Pay Amount of Minimum Notice Award by EAT Total of Columns (c), (d), (e), (
2. f)& (
3. g)(
4. a)(
5. b)(
6. c)(
7. d)(
8. e)(
9. f)(
10. g)1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Total € Schedule of Employee Entitlements Form EIP3 Company Name PAYE No. Annex (
11. a)Employee's Name PPS No. (Formerly RSI NO. Anti-Discrimination (Pay) Act, 1974 , Employment Equality Act, 1977 Unfair Dismissal Act, 1977 , Court Awards in respect of Unfair or Wrongful Dismissals Maternity Protection Act, 1994 , Adoptive Leave Act, 1995 , Parental Leave Act, 1998 National Minimum Wage Act, 2000 Statutory Minimum Wages Under an Employment Regulation Order Total of Columns (j), (k), (l), (
12. m)& (
13. n)(
14. h)(
15. i)(
16. j)(
17. k)(
18. l)(
19. m)(
20. n)1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Total € GIVEN under my hand, 17 December 2001. TOM KITT, T.D. ____________________ Minister of State at the Department of Enterprise, Trade and Employment. Explanatory Note. (This note is not part of the Instrument and does not purport to be a legal interpretation). The purpose of these Regulations is to prescribe revised formats of the forms and certificates used in connection with submission of claims under Section 6 of the Protection of Employees (Employers' Insolvency) Payments Acts, 1984 to 2001. The new forms reduce the number of forms from five to three to facilitate the claims procedure. Privacy Statement Accessibility European Legislation Identifier (PDF) Open Data License Ráiteas Príobháideachais Inrochtaineacht Aitheantóir Eorpach Reachtaíochta (ELI) Ceadúnas Sonraí Oscailte Liosta Fianán © Government of Ireland. Oireachtas Copyright Material is reproduced with the permission of the Houses of the Oireachtas © Rialtas na hÉireann. Atáirgtear ábhar faoi Chóipcheart le cead ó Thithe an Oireachtais