test Unemployment Insurance

Employer Protest of Benefit Charge

  Please complete all fields below and complete the Refusal of Work Questionnaire if appropriate, then click "Submit". You will receive a confirmation number which you should retain for your records.  All protests will be addressed in the order in which they are received. Please do not submit duplicate requests for the same employee.  

Company Name:  
Employer Registration Number (ERN):          (ERN: (10 Digits. Ex: 0012345678))  
Company Contact Person:  
Contact Person's Title:  
Telephone Number:     (Ex: 401-999-9999)  
E-mail Address:    
Employee's First Name:  
Employee's Last Name:  
Last 4 digits of employee's Social Security Number:    
Reason For Protest:  
Monthly Charge Statement Month/Year Protested:  
Employee's Last Day of Work:       Calendar 
Reason Description:  




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