Standard Affidavit Form

Document Number: UCL-17500-E

Description: This form is provided to parties to UI appeal hearings for their use per statutory requirement.

Comments: Information on how to complete the form and where to send it is included in the second page of the form.

Content Contact: UI BOLA

Document Attachment: UCL-17500-E (pdf/143 KB)

NOTE: When using Google Chrome, you may notice overlapping text when you select file, print. Deselect the 'fit to page' option and the text will no longer overlap.

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.