EMPLOYER DETAILS
Employer Registration Number (ERN) *   Business Registration Number (BRN) *
Company/Surname *   Employer Category *
 
CONTACT PERSON DETAILS
National Identity Card Number   Surname *
Other Names *   Mobile Phone No. *
Email Address
 
EMPLOYMENT DETAILS
Total Wage Bill for all Employees for March 2020 *   Wage assistance Amount (Rs) applied for *
Number of Employees under the scheme *
 
The Eligible Employers will benefit assistance from the Government as per the table below
 
For every employee with basic salary in March 2020 Basis Assistance per employee(Rs)
From 9,700 to Rs 25,000 15-days wages From Rs 4,850 to Rs 12,500
From Rs 25,000 to Rs 50,000 Fixed Amount Rs 12,500
Above Rs 50,000 Nil Nil
 
DECLARANT INFORMATION
Declarant Name   *
Capacity in which acting   *
 
I declare that:
 
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