I agree that the information provided can be relied upon by the Department of Financial Assistance to be true and correct to determine my eligibility for receipt of Supplemental Unemployment Benefit.
I fully understand the information requirements, conditions and terms of assistance stated at the time of interview and agree to provide any supporting material that the Department of Financial Assistance under the Supplementary Benefit program may require.
I further understand that the department will request repayment of assistance received if:
- I, for the purpose of obtaining any benefit, knowingly misrepresent my circumstances to the Department
- I knowingly produce or furnish any false documents or information in order to receive Supplementary Unemployment Benefits
I lastly understand that if false, misleading or inaccurate information is submitted, I will be under penalty of suspension or cancelation as stated in the Public Treasury (Administration and Payments) (Supplementary Unemployment Benefit) Regulations 2020 12(1)(a)(b)(c) and 14(1)(2)
CONSENT TO DISCLOSE AND VERIFY INFORMATION
I consent to release the information to an authorized representative of the Department of Financial Assistance for the purpose of determining and verifying my initial and ongoing eligibility for financial assistance by collecting information about myself.
I consent to release information relating to any assets, bank accounts, owned by me or jointly with other individuals, spouse, significant others, dependents or others.
I understand that this consent applies to inquiries made during a period of time which I have been in receipt of Supplementary Unemployment Benefits. I further understand that requests and responses may take the form of electronic data exchange.
In accordance with the Public Treasury (Administration and Payments) (Supplemental Unemployment Benefit) Regulations 2020, any person who knowingly makes any false statement or knowingly provides any false information will have committed an offence. Any person who commits an offence is liable on summary conviction to a fine of $1,500 or imprisonment for six months or to both such fine or term of imprisonment.