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The Pamphlet Collection of Sir Robert Stout: Volume 29

Form of Claiming Sick Benefit

page 14

Form of Claiming Sick Benefit.

Mr. Jones proposed—

Mr. Flinn seconded—


"That the following form be adopted: "—

To the Secretary of the_______Branch.

The________day of________18

Insert here cause of the inability to work.

Sir,—This is to inform you that I became, on the______day of______ 18____, incapable of working at my trade, on account of______, and I therefore request sick benefit from that date.


The claimant must here sign his name and address.



  • For 8 16 (2 votes).
  • Against 1 2 3 4 5 6 7 9 10 11 12 13 14 15 (14 votes).