S.I. No. 33/1934 - The Unemployment Assistance (Qualification Certificate Regulations) Order, 1934.

1. Name of Applicant............................................................ ............................................................ ..........................

2.

PARTICULAR OF DEPENDANTS.

Name

Relationship to you

Date of Birth

If employed enter "Yes." If employed enter "No."

(a) Are the dependants under 18 years of age your unemployed children or step children and wholly or mainly supported by you ?

............................................................ ..............

(b) If they are not your children or step children what responsibility for them have you undertaken ?

............................................................ ..............

(c) If your mother is a dependant

(i) Have you undertaken responsibility for her support ?

............................................................ ...............

(ii) Why is she unable to support herself ?

............................................................ ...............

(iii) Is her husband unable to support himself and, if so, why ?

............................................................ ...............

(d) If your father is a dependant

(i) Have you undertaken responsibility for his support ?

............................................................ ..............

(ii) Why is he unable to support himself ?

............................................................ ..............

(e) If orphan brothers or sisters are dependants

(i) Are they normally supported by you ?

............................................................ ..............

(ii) Why are they unable to support themselves ?

............................................................ .............

(f) Do any other persons contribute in any way to the support of any of your dependants and, if so, to what extent ?

............................................................ ............

(g) Do all your dependants reside with you ?

............................................................ ............

2. Home Address ............................................................ ............................................................ ................ (The full postal address and the County Borough, Borough, Urban District or County must be stated)

3. If a married woman

(a) Are you dependent on your husband ?

............................................................ ............

(b) Is your husband dependent on you ?

............................................................ ............

(c) Does your husband live with you ?

............................................................ ...........

(d) Is he unable to support himself, and, if so, why ?

............................................................ ...........

4. If a widow or spinster with no dependant

(a) State the number of your Unemployment Book

............................................................ ...........

(b) State the number of contributions paid thereon

............................................................ ...........

(c) Were such contributions paid by your employer in respect of employment insurable under the Unemployment Insurance Acts ?

............................................................ ...........

I have clearly understood the above questions and to the best of my knowledge and belief all the statements made by me in this application are correct.

I, hereby, apply for a Qualification Certificate under the

Unemployment Assistance Act, 1933

.

Signature (or mark) of applicant............................................................ .........................................

Date............................................................ ............................................................ ............................

Signed (or mark made) in my presence............................................................ .............................

Witness............................................................ ............................................................ .....................

Address............................................................ ............................................................ .....................

STATUTORY DECLARATION BY APPLICANT.

I, do solemnly and sincerely declare that, to the best of my knowledge and belief all the statements which I have made in this application are true, and all the questions therein which I have answered are truly and fully answered in all respects, and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the provisions of the Statutory Declarations Act, 1835.

(Signed)

Taken and received by me.

Dated this day of 193 .

(Signed)

Peace Commissioner or duly

authorised office

SECOND SCHEDULE.

UNEMPLOYMENT ASSISTANCE ACT, 1933

.

QUALIFICATION CERTIFICATE.

Number................................

It is hereby certified that............................................................ ...........................................................(.....................................) born at............................................................ ................................... and residing at............................................................ ........................ fulfils the conditions set out hereon.

The Holder's weekly rate of means corresponding to the annual rate calculated in accordance with the

Unemployment Assistance Act, 1933

, is............................................................ ............................................................ .....

Official

Stamp

Unemployment Assistance Officer.

Date............................................................ ..............................................

To be completed immediately on receipt of certificate

Signature of Holder............................................................ ....................

Witness to signature............................................................ .................

Address............................................................ .......................................

The conditions to be fulfilled by a person obtaining or holding a qualification certificate under the

Unemployment Assistance Act, 1933

, are :—

(

a

) that he is a National of Saorstát Eireann ;

(

b

) that he has attained the age of eighteen years and has not attained the age of seventy years ;

(

c

) that his means, calculated in accordance with this Act, do not exceed, in case he is resident in a county borough or the borough of Dún Laoghaire, fifty-two pounds or, in case he is resident elsewhere in Saorstát Eireann, thirty-nine pounds per annum ;

(

d

) in the case of a married woman either :—

(i) that her husband is a dependant of her, or

(ii) that neither she nor her husband is a dependant of the other and she has one or more dependants ;

(

e

) in the case of a widow or spinster, that she has one or more dependants ;

(

f

) in the case of a widow or spinster, who has no dependant, that not less than fifty-two contributions have been paid in respect of her under the Unemployment Insurance Acts, 1920 to 1930, as amended by any subsequent enactment, during the period of four years immediately preceding the date of the application.

5. Date of Birth............................................................ ............................................................ .....................................

6. Place where born............................................................ ............................................................ ...................... (exact address)

7. *Place where mother ordinarily resided at date of your birth............................................................ .

8. *Places where you have ordinarily resided during the past five years.............................................

*If place where born is within Saorstát Eireann replies are not required.

9. Give particulars of Employments during the past two years :—

Employer

Occupation

Period

From

To

10. Have you a farm, a business, or any house or other property, or have you any right in any property ?

... ...........................................................

(a) If so, state where it is situated

............................................................ ...

(b) Describe it giving such particulars as Poor Law Valuation, Rent, turn over, etc.

............................................................ ..

11. (a) Do you pay rent for the house or lodging in which you reside, or do you own it ?

............................................................ ..........................

(b) If you pay rent, give particulars, stating whether it is payable under a lease or a yearly or shorter tenancy

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*p0781a How much have you coming in per week in money ?

............................................................ ..........................

(a) From what sources is such money derived ?

............................................................ .........................

(b) What contributions do you receive from members of your household or others towards household expenses ?

............................................................ .........................

*The following should not be included :—

(

a

) Money earned in respect of current personal employment under a contract of service.

(

b

) Money received by way of benefit under the National Health or Unemployment Insurance Acts or the Unemployment Assistance Act.

(

c

) Money received by way of Home Assistance.

(

d

) Income from money or property described elsewhere in this form.

13. Have you money in hand, at Bank, or invested ?

............................................................ ................

14. Have you money coming in from any other source ?

............................................................ ................

15. What other means of subsistence have you ?

............................................................ ................

16. Have you had in the last twelve months any property or income which you do not own or receive at present ? If so, what has become of it ?

............................................................ ................

17. (a) If you do not own or pay rent for your house or lodging, with whom do you reside ?

............................................................ ...........

(b) What is your relationship to such person ?

............................................................ ...........

(c) What contribution do you make for your board and/or lodging ?

............................................................ ...........

18. Have you previously applied for a Qualification Certificate? If so, state when and where

............................................................ .............

I have clearly understood the above questions, and to the best of my knowledge and belief all the statements made by me in this application are correct.

I, hereby, apply for a Qualification Certificate under the

Unemployment Assistance Act, 1933

.

Signature, or mark of Applicant

............................................................ .............

Date

............................................................ ...........................

Signed (or mark made) in my presence

............................................................ ...........................

Witness

............................................................ ..........................

Address

............................................................ ..........................

STATUTORY DECLARATION BY APPLICANT.

I, do solemnly and sincerely declare that to the best of my knowledge and belief all the statements which I have made in this application are true, and all the questions therein which I have answered are truly and fully answered in all respects, and I make this solemn declaration conscientiously believing the same to be true and by virtue of the provisions of the Statutory Declarations Act, 1835.

(Signed)

Taken and received by me.

Dated this day of 193 .

(Signed)

Peace Commissioner or duly authorised officer.

CONTINUATION OF APPLICATION FOR A QUALIFICATION CERTIFICATE.

(To be completed by Women Applicants only.)

STATUTORY RULES AND ORDERS. 1934. No. 33.

THE UNEMPLOYMENT ASSISTANCE (QUALIFICATION CERTIFICATE REGULATIONS) ORDER, 1934.

THE UNEMPLOYMENT ASSISTANCE (QUALIFICATION CERTIFICATE REGULATIONS) ORDER, 1934, MADE BY THE MINISTER FOR INDUSTRY AND COMMERCE ON THE 15th DAY OF FEBRUARY, 1934, PURSUANT TO

SECTION 7

of THE

UNEMPLOYMENT ASSISTANCE ACT, 1933

.

WHEREAS it is enacted by subsection (1) of

section 7

of the

Unemployment Assistance Act, 1933

, that the Minister for Industry and Commerce may by order make regulations prescribing any matter or thing which is referred to in the said Act as prescribed or to be prescribed or any matter or thing which is expressly authorized by the said Act to be prescribed by regulations made by the Minister under the said Act

NOW, THEREFORE, the Minister for Industry and Commerce in exercise of the powers conferred on him by subsection (1) of

section 7

of the

Unemployment Assistance Act, 1933

, and of every and any other power him in this behalf enabling hereby orders as follows, that is to say :—