S.I. No. 356/1984 - Protection of Employees (Employers' Insolvency) (Forms and Procedure) Regulations, 1984.

1. After comletion, this form should be sent or returned to the insolvent employer's representative.

2. The insolvent employer's representative is the person appointed in connection with an employer's insolvency (e.g. receiver, liquidator, person appointed by Minister for Labour).

3. A separate form IP1 should be completed where payment is being claimed in respect of arrears of wages, sick pay and holiday pay and form IP2 should be used for claims in repect of Minimum Notice awards by the Employment Appeals Tribunal.

4. Claims in respect of statutory minimum wages can only be made in respect of employments covered by an Employment Regulation Order. In case of doubt, about the application of an Employment Regulation Order, claimants should contact the General Inspectorater Section of this Department.

5. Please attach a copy of Recommendation, deterimation or order as appropriate, if available.

6. Warning: Legal Proceedings may be taken against anyone making a false statement on this form.

PART 1

COMPLETE THIS FORM IN BLOCK CAPITALS

Employee's

Surname

Employee's Revenue and Social Insurance (R.S.I.) Number

Employee's

First Name

Figures

Letters

Address of Employee

|___|___|___|___|___|___|___|___|___|

________________________

Business name and address of insolvent Employer: -

________________________

___________________________________

________________________

___________________________________

Occupation

Date of Termination of Employment

___________________________________

DayMonthYear

___________________________________

|____|_____|____|

Address of place of Employment

Gross Weekly Pay £

PART 2 : ANTI - DISCRIMINATION (PAY) ACT, 1974

(1) Equality Officer Recommendation (Note: attach copy of recommendation).

Day

Month

Year

Date of Recommendation

Reference Number

Amount of Recommendation ————————————————————————————————————

£

Has an appeal been lodged with the Labour Court?————————————

Yes

tick

appropriate

No

box

(Note: If an appeal has been lodged, no payment can be made unless it is withdrawn, or is determined by the Labour Court. If it has been determined by the Labour Court, please complete section 2 following).

(2) Labour Court Determination (Note: attach copy of determination).

Day

Month

Year

Date of Determination—

Reference Number

Amount of Award

£

Has an appeal been lodged with the High Court?—————————————

Yes

tick

appropriate

No

box

(3) Fine arising out of Civil Court decision (note: attach copy of decision if available).

Day

Month

Year

Date of Decision————

Amount of Award

£

Location of Sitting———

(4) Compensation awarded by Labour Court or Civil Court (note: attach copy of award).

Who awarded the compensation

Labour Court

tick

Civil Court

appropriate box

Day

Month

Year

Date of Decision————

Amount of Award

Reference Number———

Location of Sitting———

(if any)

(if heard in Civil Court)

(5) High Court Judgement (note: attach copy of judgement).

Day

Month

Year

Date of Judgement———

Amount of Award

£

PART 2 : ANTI - DISCRIMINATION (PAY) ACT, 1974

(1) Equality Officer Recommendation (Note: attach copy of recommendation).

Day

Month

Year

Date of Recommendation

Reference Number

Amount of Recommendation ————————————————————————————————————

£

Has an appeal been lodged with the Labour Court?————————————

Yes

tick

appropriate

No

box

(Note: If an appeal has been lodged, no payment can be made unless it is withdrawn, or is determined by the Labour Court. If it has been determined by the Labour Court, please complete section 2 following).

(2) Labour Court Determination (Note: attach copy of determination).

Day

Month

Year

Date of Determination—

Reference Number

Amount of Award—————————————————————————————————————————

£

Has an appeal been lodged with the High Court?—————————————

Yes

tick

appropriate

No

box

(3) Fine arising out of Civil Court decision (note: attach copy of decision if available).

Day

Month

Year

Date of Decision————

Amount of Award

£

Location of Sitting———

(4) Compensation awarded by Labour Court or Civil Court (note: attach copy of award).

Who awarded the compensation

Labour Court

tick

Civil Court

appropriate box

Day

Month

Year

Date of Decision————

Amount of Award

Reference Number———

Location of Sitting———

(if any)

(if heard in Civil Court)

(5) High Court Judgement (note: attach copy of judgement).

Day

Month

Year

Date of Judgement———

Amount of Award

£

PART 3

EMPLOYMENT EQUALITY ACT, 1977

(1) Equality Officer Recommendation (Note: attach copy of recommendation).

Day

Month

Year

Date of Recommendation

Reference Number

Amount of Recommendation ————————————————————————————————————

£

Has an appeal been lodged with the Labour Court?————————————

Yes

tick

No

appropriate box

(Note: If an appeal has been lodged, no payment can be made unless it is withdrawn, or is determined by the Labour Court. If it has been determined by the Labour Court. If it has been determined by the Labour Court, please complete section 2 following).

(2) Labour Court Determination (Note: attach copy of determination).

Day

Month

Year

Date of Determination—

Reference Number

Amount of Award—————————————————————————————————————————

£

Has an appeal been lodged with the High Court?—————————————

Yes

tick

No

appropriate box

(3) Damages/Fine arising out of Civil Court decision (Note: attach copy offine/award, if available).

What did the Civil Court Award?—————

Damages

tick

Fine

appropriate box

Day

Month

Year

Date of Decision————

Amount of Award

£

Location of Sitting———

(4) Compensation awarded by Labour Court or Civil Court (note: attach copy of award).

Day

Month

Year

Date of award of compensation—————

Reference Number

Amount of Award—————————————————————————————————————————

£

Has an appeal been lodged with the High Court?—————————————

Yes

tick

No

as appropriate

(5) High Court Judgement (note: attach copy of judgement).

Day

Month

Year

Date of Judgement———

Amount of Award

£

PART 4 : 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.

State title of Employment

Regulation Order——————————————

Have proceedings been instituted against the employer————————————

Yes

tick

No

appropriate box

If yes, by whom—————

In which Court (if applicable) —————————

State period in respect of which the claim is being made

Day

Month

Year

Day

Month

Year

Total number

From

To

of weeks—————————

Total Arrears Claimed —————————————————————————————————————

£

PART 5

UNFAIR DISMISSALS ACT, 1977

(1) Rights Commissioner Recommendation (Note: Attach copy Recommendation).

Day

Month

Year

Date of Recommendation—

Amount of Award——

£

Has an appeal been lodged with the Employment Appeals Tribunal?——————————

Yes

tick

No

appropriate

(2) Employment Appeals Tribunal Determination (Note: Attach copy of determination).

Day

Month

Year

Date of Determination———

Reference Number

Amount of Award————————————————————————————————

£

Has an appeal been lodged with the Circuit Court?—————————————————

Yes

tick

No

appropriate box

(3) Court Order (See note below)

Day

Month

Year

Date of Order——————

Amount of Award——

£

I apply for payment due to me under the Protection of Employees (Employer's Insolvency) Act, 1984 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 this amount will be transferred to the Minister for Labour 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 anybody else.

Signature

_______________________

Date

_____________________________

Note: This part should also be used to claim payment of court awards for damages at common law for wrongful dismissal.

FORM 1P 5

APPLICATION BY AN EMPLOYER'S REPRESENTATIVE FOR FUNDS TO PAY ENTITLEMENTS UNDER AN EMPLOYMENT REGULATION ORDER,

UNFAIR DISMISSALS ACT, 1977

, ANTI-DISCRIMINATION (PAY) ACT, 1974 AND

EMPLOYMENT EQUALITY ACT, 1977

.

An Roinn Saothair - Department of Labour

Protection of Employees (Employer's Insolvency) Act, 1984.

PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS

Business Name of Insolvency Employer

Employer's P.A.Y.E Registered Number

_________________________________

Figures

Letter

Business address of Insolvency Employer

|__|__|__|__|__|__|__|__|

_________________________________

Day

Month

Year

_________________________________

Date of Insolvency

_________________________________

(eg date of appointment of Liquidator, Receiver ect.)

Nature of Business

For Office Use

Type of Insolvency

Nace

(e.g. liquidation, receivership, bankruptcy, etc)

________________________________________________

To: Minister for Labour, Davitt House, Mespil Road, Dublin 4.

In connection with the provisions of the Protection of Employees (Employer' Insolvency) Act, 1984, I have accepted, to the best of my knowledge, the entitlement of the employees as shown in this form. No other notification has been made by me in respect of these entitlements. I understand that it may be necessary for you refer information on the entitlements to the Revenue Commissioners and Government Departments. I hereby give my consent to the disclosure of such information as may be necessary. I also agree to make available to you such records as may be required for examination. I undertake to distrivute the appropriate amounts to the employees concerned from the funds received pursuant to this application.

I declare in respect of the amounts shown on this form for the employees concerned that I have made no appeal in relation to the amounts shown and I am not aware, to the best of my knowledge, that these amounts are the subject of appeal by the employees concerned or anybody else.

The instrument of payment should be

drawn in favour of———————————

Address—————————

Signature of Employer's Representative

_________________________________

Date :__________________

Telephone

________________

1

2

3

4

5

6

7

Employer's Name

Revenue and Social Insurance Number

Amount under the Anti- Discrimination (Pay) Act, 1974.

Amount under the

Employment Equality Act, 1977

.

Amount under

Unfair Dismissals Act, 1977

or Court Order for wrong ful dismissal

Amount under the Industrial Relation Act, 1946 (Employment Regulation Order)

Total of Columns (3), (4), (5) and (6).

£

£

£

£

GRAND TOTAL

£

S.I. No. 356 of 1984.

PROTECTION OF EMPLOYEES (EMPLOYERS' INSOLVENCY) (FORMS AND PROCEDURE) REGULATIONS, 1984.

I, RUAIRI QUINN, Minister for Labour, in exercise of the powers conferred on me by

sections 6

and

16

of the

Protection of Employees (Employers' Insolvency) Act, 1984

(No. 21 of 1984), hereby make the following regulations