Claim for Pandemic Leave Disaster Payment form (EM252)

Use this form to claim the Pandemic Leave Disaster Payment.

Fill in claim forms completely before submitting

You can fill in this form and sign it digitally. You can do this by downloading it on a computer that has Adobe Acrobat Reader. If you don’t have Adobe Acrobat Reader you can print it and sign it by hand.

Page last updated: 18 January 2022