S.I. No. 581/2001 - Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 2001.
I, TOM KITT, Minister of State at the Department of Enterprise, Trade and Employment in exercise of the powers conferred on me by section 6 and 16 of the Protection of Employees (Employees' Insolvency) Act, 1984 (No. 21 of 1984) and the Labour (Transfer of Departmental Administration and Ministerial Functions) Order, 1993 ( S.I. No. 18 of 1993 ) as adapted by the Enterprise and Employment (Alteration of Name of Department and Title of Minister) Order, 1997 ( S.I. No. 305 of 1997 ), and the Enterprise, Trade and Employment (Delegation of Ministerial Functions) No. 2 Order, 1997 ( S.I. No. 330 of 1997 ) hereby make the

following regulations:
1.       (1)      These Regulations may be cited as the Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 2001.
(2)      These Regulations shall come into operation on 1 January, 2002.
2.      In these Regulations -
“the Act” means the Protection of Employees (Employers' Insolvency) Act, 1984 (No. 21 of 1984);
“Principal Regulations” means the Protection of Employees (Employers' Insolvency) (Forms and Procedure) Regulations, 1984 ( S.I. No. 356 of 1984 );
and
“Regulations of 1991” means the Protection of Employees (Employers' Insolvency) (Forms and Procedure) (Amendment) Regulations, 1991 ( S.I. No. 349 of 1991 ).
3.      The Principal Regulations (as amended by the Regulations of 1991) are amended by -
(a)      The substitution for Regulation (3) of the following Regulation as Regulation (3):
“3.      (1)      The following forms are prescribed as the forms to be used as regards applications under section 6 of the Act:
(a)      in the case of an application for payment in respect of the period of minimum notice specified under section 4 of the Minimum Notice and Terms of Employment Act, 1973 (No. 4 of 1973), the form (Form EIP 2) set out in Part 2 of the Schedule to these Regulations; and
(b)      in the case of an application for payment in respect of any other case to which section 6 of the Act applies, the form (Form EIP 1) set out in Part 1 of the Schedule to these Regulations.”,
(b)      the substitution in Regulation 4(b)(ii) of “the Secretary General, Department of Enterprise, Trade and Employment, Davitt House, 65A Adelaide Road, Dublin 2.” for “the Secretary, Department of Labour, Davitt House, 65A Adelaide Road, Dublin 2.”,
(c)      by the substitution for paragraph (2) of Regulation 5 of the following paragraph:
“(2)      A statement required by paragraph (1) of this Regulation shall be made by means of the form (Form EIP 3) set out in Part 3 of the Schedule to these Regulations.”,
(d)      The insertion after Regulation 6 of the following as Regulation 7:
“7.      A person shall be deemed to have complied with any requirements under these Regulations to make an application or to prepare a statement in a form prescribed by these Regulations where the application or statement, as case may be, is made in a form to like effect to the prescribed form concerned.”,
and
(e)      The substitution of the matter in the Schedule to these Regulations for the matter in the Schedule to the Principal Regulations.
SCHEDULE
Part 1
Form EIP1
Department of Enterprise, Trade and Employment
EMPLOYEE'S APPLICATION FOR PAYMENT(S) UNDER THE INSOLVENCY PAYMENTS SCHEME
An Roinn Fiontar, Trádála agus Fostaíochta
Department of Enterprise, Trade and Employment
Insolvency Payments Scheme
Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001
Part 1      Your Details
(Please complete in Block Capitals)
Figures
Letters
Employee's PPS no. (formerly RSI no.)
 
Employee's Surname
 
Employee's First name
 
Employees Address
 
 
 
 
 
 
Date of Birth
Day
Mth
Yr
 
Class of Insurance

Please attach copy of P45 if available
Part 2      Employer Details
Name of Employer
 
Employer's full address
 
 
 
 
 
 
Business
 
Is your employer formally insolvent?

(i.e. in Liquidation, Receivership etc)
 
Name of Receiver/ Liquidator/ Employer Representative
 
Telephone no.
Part 3      Employment Details
Occupation
 
Date of Commencement of employment
Day
Mth
Yr
 
Date of Termination of employment
Day
Mth
Yr
 
Gross Weekly Pay
€
Wk
Mth
 
No of days and hours normally worked per week
Days
Hours
 
Director
Secretary
Shareholder
Were you a Director/Secretary or Shareholder of the Company.

(please tick as appropriate)
Part 4      Arrears of Wages
Are you owed any wages?
Yes
No
Tick the Yes Box if you are owed wages, overtime, bonus or commission payments and give details in the spaces provided.
If wages claim include bounced cheques please attach bounced cheque. In relation to overtime, bonus and commission, please see note 6.
Type
From
To
No. of weeks/days
Gross weekly wage
Amount Due
(wages bonus etc)
Day
Mth
Year
Day
Mth
Year
(Actual)
€
€
€
€
€
€
€
€
Average (if required) See note 6
€
 
Total Arrears of Wages Claimed
€
Deductions from wages : i.e Union Dues, V.H.I., etc.
Type
From
To
No. of weeks
Gross weekly wage
Amount Due
Day
Mth
Year
Day
Mth
Year
€
€
€
€
€
€
€
€
Total Arrears of Deductions Claimed
€
Part 5      Arrears of Holiday Pay
From
To
Total no. of weeks due
Day
Mth
Year
Day
Mth
Year
(incl. Any public hols. due)
 
 
 
 
 
 
 
Annual Leave Entitlement
No. of days
 
Annual Leave Taken
No. of days
 
Public Holidays Due
No. of days
 
Gross Weekly Pay
€
 
Arrears of Holiday Pay Claimed
€
Part 6      Arrears due under a Company Sick Pay Scheme
From
To
Total no. of weeks due
Day
Mth
Year
Day
Mth
Year
(incl. Any public hols. due)
 
 
 
 
 
 
 
Weekly amount of Social Welfare Benefit
€
 
Total Amount of Social Welfare Benefit payable during the period
€
 
Weekly payment by Employer under Sick Pay Scheme (Exclusive of Social Welfare payments)
€
 
Gross Weekly Pay
€
 
Total Arrears of Sick Pay Claimed
€
Part 7       Anti-Discrimination (Pay) Act, 1974 or Employment Equality Act, 1977
Anti Discrimination(Pay) Act, 1974
 
Employment Equality Act, 1977

(please tick as appropriate)
Date
Amount
Reference No.
Has an appeal been
Day
Mth
Year
lodged Y/N
Equality Officer Recommendation
€
Labour Court Determination
€
Civil Court award
€
Labour/ Civil Court Compensation
€
High Court Judgement
€
Note: Please attach copy of recommendation, determination, decision, award or judgement as appropriate.
Date refers to date of recommendation, determination, decision, etc
Part 8       Unfair Dismissals Act, 1977 or Court Awards in respect of Unfair or Wrongful Dismissal
Date
Amount
Reference No.
Has an appeal been
Day
Mth
Year
lodged Y/N
Rights Commissioner Recommendation
€
Employment Appeals Tribunal Determination
€
Circuit Court Order
€
High Court Judgement
€
Note: Please attach copy of recommendation, determination, order or judgement as appropriate.
Date refers to date of recommendation, determination, order, etc.
Part 9       Maternity Protection Act, 1994 , Adoptive Leave Act, 1995 or Parental Leave Act, 1998
Maternity Protection Act, 1994
 
Adoptive Leave Act, 1995
 
Parental Leave Act, 1998 (please tick as appropriate)
Date
Amount
Reference No.
Has an appeal been
Day
Mth
Year
lodged Y/N
Rights Commissioner Recommendation
€
Employment Appeals Tribunal Determination
€
Circuit Court Order
€
Note: Please attach copy of recommendation, determination, or order as appropriate.
Date refers to date of recommendation, determination, order, etc.
Part 10       National Minimum Wage Act 2000
Date
Amount
Reference No.
Has an appeal been
Day
Mth
Year
lodged Y/N
Rights Commissioner Decision
€
Labour Court Determination
€
High Court Judgement
€
Note: Please attach copy of decision, determination or judgement as appropriate.
Date refers to date of decision, determination, judgement, etc.
Part 11      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.
Title of Employment Regulation Order
 
Have proceedings been instituted against the employer (Please tick appropriate box)
YES
NO
 
If Yes, by whom
 
In which Court (if applicable)
 
State the period in respect of which the claim is being made
From
To
Day
Mth
Year
Day
Mth
Year
 
 
 
 
 
 
 
Total No. of Weeks
 
Gross Weekly pay
€
 
Total Claimed
€
 
I apply for payment due to me under the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 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 these amounts will be transferred to the Minister for Enterprise, Trade and Employment 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 someone else.
Signature:______________________________________
Date:_________________________
 
WARNING: LEGAL PROCEEDINGS MAY BE TAKEN AGAINST ANYONE MAKING A FALSE STATEMENT ON THIS FORM
Part 2
Form EIP2
Department of Enterprise, Trade and Employment
INSOLVENCY PAYMENTS SCHEME
Protection of Employees (Employers' Insolvency) Acts 1984 to 2001
EMPLOYEE'S APPLICATION FOR PAYMENT OF AN AWARD UNDER THE MINIMUM NOTICE AND TERMS OF EMPLOYMENT ACT, 1973
PART 1 COMPLETE THIS FORM IN BLOCK CAPITALS
Employee's

Surname:
Employee's PPS No. (Formerly R.S.I No.)
Employee's
Figures
Letters
First Name:
Address of Employee
 
_______________________________________
Business name and address of insolvent Employer:-
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Occupation
Date of Termination of Employment
_______________________________________
_______________________________________
Day
Month
Year
 
 
Address of place of employment
 
 
PART 2:  AWARD BY THE EMPLOYMENT APPEALS TRIBUNAL UNDER SECTION 12 OF THE MINIMUM NOTICE AND TERMS OF EMPLOYMENT ACT, 1973
Day
Month
Year
Date of Employment Appeals Tribunal Award_________________________________
 
Reference number of award_______________________________________________
 
Gross weekly Wage__________________________________________________________
€
 
Total Amount Claimed/due____________________________________________________
€
PLEASE ATTACH A COPY OF THE TRIBUNAL AWARD
I apply for payment due to me under the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001 and declare that I have made no other applications in respect of the amount shown above. I am aware that my rights and remedies against my employer in respect of this amount will be transferred to the Minister under the Protection of Employees (Employers' Insolvency) Act, 1984 .
Signature________________________________
Date__________________
WARNING: Legal proceedings may be taken against anyone making a false statement on this Form.
WHEN COMPLETED PLEASE RETURN FORM TO LIQUIDATOR/RECEIVER
Part 3
Form EIP3
Department of Enterprise, Trade and Employment
Insolvency Payments Scheme
Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001
APPLICATION BY A RELEVANT OFFICER FOR FUNDS IN RESPECT OF:
WAGES, HOLIDAY PAY, SICK PAY, MINIMUM NOTICE AWARDS, ENTITLEMENTS UNDER THE ANTI-DISCRIMINATION (PAY) ACT, 1974 , EMPLOYMENT EQUALITY ACT, 1977 , UNFAIR DISMISSALS ACT, 1977 , COURT AWARDS IN RESPECT OF UNFAIR OR WRONGFUL DISMISSAL, MATERNITY PROTECTION ACT, 1994 , ADOPTIVE LEAVE ACT, 1995 , PARENTAL LEAVE ACT, 1998 , NATIONAL MINIMUM WAGE ACT, 2000 AND STATUTORY MINIMUM WAGES UNDER AN EMPLOYMENT REGULATION ORDER.
IMPORTANT: PLEASE READ NOTES BELOW BEFORE COMPLETING THIS FORM
1.
When making an initial claim to the Insolvency Payments Section on behalf of the former employees of an Insolvent Company, copies of the following documentation must be attached:
(a)      Notice of appointment of Liquidator/Receiver
(b)      Statement of Affairs/Accounts
2.
Initial claims for each employee should be accompanied by a copy of the employee's P45 or written confirmation of his/her class of insurance.
3.
PLEASE NOTE THAT FAILURE TO COMPLETE THE FORM FULLY MAY RESULT IN DELAY IN MAKING THE PAYMENT.
DETAILS OF INSOLVENT COMPANY
Employer's PAYE Registered Number
Figures
Letter
 
 
Name of company
 
Business Address
 
 
 
 
Nature of Business
 
Names of Directors/Company Secretary
PPS No. (Formerly RSI No.)
%
Figures
Letters
Shareholding
 
 
 
Date of Insolvency
day
Mth
Year
 
Type of Insolvency
RELEVANT OFFICER CERTIFICATE
Name of Relevant Officer
 
Name of Company
 
Business Address
 
 
 
 
Phone No.
 
Relevant Office Tax No.
Figures
Letter
 
Please attach a schedule of employee entitlements, Annex EIP3(a) attached shows the format required. Please ensure that your schedule is clearly headed by the company name and PAYE No. You may use the attached example if you wish.
How many pages of Annex EIP3(a) are attached?
Declaration
To: Minister for Enterprise, Trade and Employment
In connection with the provisions of the Protection of Employees (Employers' Insolvency) Acts, 1984 to 2001, I have accepted, based on the best information available to me, the entitlement of the employees as shown on the attached schedule. No other application has been made by me in respect of these entitlements. I understand that it may be necessary for you to refer information on the entitlements to the Revenue Commissioners and/or to other Government Departments. I hereby give my consent to the disclosure of such information as is in my possession. I also agree to make available to you such records as may be required for examination. I undertake to distribute the appropriate amounts to the employees concerned from the funds received pursuant to this application. Copies of employee claims on the relevant forms are attached.
I declare that the company is insolvent and that there are no funds available from which the entitlements claimed on the attached schedule can be paid.
The Instrument of payment should be drawn in favour of (Relevant Officer)
 
Address
 
 
 
 
Signature of Relevant Officer
 
Date
 
Department of Enterprise, Trade and Employment
Tel:
(01) 6312121
Davitt House
Fax:
(01) 6313273
65a Adelaide Road
Web:
www.entemp.ie
Dublin 2
Lo-call
1890 220222
Schedule of Employee Entitlements
Form EIP3
Company Name
 
PAYE No.
Annex (a)
Employee's Name
PPS No. (Formerly RSI NO.
Total Arrears of Wages
Deductions for union dues, V.H.I. etc.
Total Arrears of Holiday Pay
Total Arrears of Sick Pay
Amount of Minimum Notice Award by EAT
Total of Columns (c), (d), (e), (f) & (g)
(a)
(b)
(c)
(d)
(e)
(f)
(g)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
 
Total
€
Schedule of Employee Entitlements
Form EIP3
Company Name
 
PAYE No.
Annex (a)
Employee's Name
PPS No. (Formerly RSI NO.
Anti-Discrimination (Pay) Act, 1974 , Employment Equality Act, 1977
Unfair Dismissal Act, 1977 , Court Awards in respect of Unfair or Wrongful Dismissals
Maternity Protection Act, 1994 , Adoptive Leave Act, 1995 , Parental Leave Act, 1998
National Minimum Wage Act, 2000
Statutory Minimum Wages Under an Employment Regulation Order
Total of Columns (j), (k), (l), (m) & (n)
(h)
(i)
(j)
(k)
(l)
(m)
(n)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
 
Total
€
GIVEN under my hand,

17  December 2001.
TOM KITT, T.D.
____________________

Minister of State at the Department of Enterprise, Trade and Employment.
Explanatory Note.
(This note is not part of the Instrument and does not purport to be a legal interpretation). The purpose of these Regulations is to prescribe revised formats of the forms and certificates used in connection with submission of claims under Section 6 of the Protection of Employees (Employers' Insolvency) Payments Acts, 1984 to 2001.
The new forms reduce the number of forms from five to three to facilitate the claims procedure.