News & Updates
Timeline of Events
Healthcare
Travel

Government of Anguilla

Anguilla Support

Fill out the unemployment assistance application below to get started.

Important

Please note:

Registration with social security is necessary before you can receive this assistance. You are encouraged to register before submitting this application.

Section A
Applicant's identification
Section B-1:
Eligibility Part One
Section B-2:
Eligibility Part Two
Section C
Final overview

Please ensure that you complete all fields before moving to the next section.

Surname

Looks good...

Please fill in this field.

First name

Looks good...

Please fill in this field.

Your gender

Male

Female

Telephone no.

Format: +1 (264) XXX-XXXX

Looks good...

Please fill in this field.

Email address

Looks good...

Please fill in this field.

Date of Birth

Format: DD/MM/YYYY

Looks good...

Please fill in this field.

Address

Looks good...

Please fill in this field.

Mailing Address

Looks good...

Please fill in this field.

(If different from address)

Bank name

Looks good...

Please fill in this field.

Account #

Looks good...

Please fill in this field.

Bank account type

XCD

USD

Please ensure that you complete all fields before moving to the next section.

Which of the following best describes you (select one)

Regular employee

Self employed

Casual worker

Name(s) of last employer(s)/ business(es)

Looks good...

Please fill in this field.

Format: Employer 1, Employer 2

Address(es) of employer(s)/ business(es)

Looks good...

Please fill in this field.

Format: Address 1, Address 2

Telephone number(s) of employer(s)/ business(es)

Looks good...

Please fill in this field.

Format: Number 1, Number 2

Were you employed with this employer/ business on 1st Feb 2020?

Yes

Which of the following options best decribe you?

I have been unemployed as a result of the impact of Covid-19 on my place of work/business

I am still working but, I have been underemployed (ie. earning less than EC$800 a month) as a result of the impact of Covid-19 on my place of work/ business?

Enter date on which you became employed or underemployed

Looks good...

Please fill in this field.

How many children under the age of 18 currently reside in your household?

Looks good...

Please fill in this field.

Enter a number

What is the age breakdown?

0-2 years

3-5 years

6-14 years

15-17 years

(Select all that apply)

Please ensure that you complete all fields before moving to the next section.

Please state your average earnings before 1st February 2020

US$

EC$

Enter amount (Eg. 2,620.00)

Looks good...

Please fill in this field.

Per week/month?

Week

Month

Please state your average earnings now (if underemployed):

US$

EC$

Enter amount (Eg. 1,200.00)

Per week/month?

Week

Month

*Please ensure you select/circle the correct currency and pay period.

If self-employed, please indicate what you will provide as proof of income to support your claim?

If you have a business licence, provide the licence # and date registered.

Looks good...

Please fill in this field.

Have you been contributing to social security?

Yes

Enter your social security number...

Looks good...

Please fill in this field.

Are you now registered with social security?

Yes

Enter your social security number...

Looks good...

Please fill in this field.

Note: Registration with social security is necessary before you can receive this assistance. You are encouraged to register before submitting this application.

Are you currently in receipt of a Social Security benefit?
(Eg. maternity/ sickness/ unemployment)

Yes

Please state the benefit:

Looks good...

Please fill in this field.

Please ensure that you complete all fields before submitting this form.

I declare that the information given above is true to the best of my knowledge and I assume full responsibility as to its correctness. I understand that if I deliberately provide any incorrect information and receive any unemployment assistance to which I am not entitled, I will have to repay the money and may be subject to legal action. I also understand that as a condition of receiving this assistance I will hereafter be required to make contributions to the Social Security Fund and the information submitted will be transferred to Social Security.

Signature of Employee

Looks good...

Please fill in this field.

Today's date

Looks good...

Please fill in this field.

Everything looks good. Submitting your form now!

required inputs: