| TURKISH EMPLOYMENT AGENCY NOTICE OF RESIGNATION (SAMPLE) |
| 1 – EMPLOYER INFORMATIPN |
| Name Surname/Title Workplace Address Province: District: | SSK workplace registration no: |
| Trade registry no: |
| Date of establishment (day/month/year): |
| Main field of work: |
| Tel: Fax: | Scope Public Private |
| 2 – INSURED INFORMATION |
| Name Surname | SSK registration no: |
| Residence Address: Province: District: | Date of birth (day/month/year): |
| Place of birth: |
| Tel: Fax: | Mother name: |
| Gender: Female Male | Father’s name: |
| 193 No. Income Tax Law No. 31 will be filled in for those who are within the scope of Article 31. |
| Disability Rate % | Disability Tax Deduction 1 2 3 |
| 3- Fund Information (To be filled in if the insured is covered by the provisional article 20 of the Law No. 506) |
| Fund name: | Insured Fund Registry No: |
| 4- Work information of the insured person at the workplace |
| Date of employment (day/month/year): | Date of dismissal (day/month/year): |
| Reason for dismissal: | Position at workplace: |
| Last monthly net salary: |
| Premium records at the workplace in the last 120 days (To be filled in retrospectively starting from the last month) |
| Year | Month | Last monthly net salary: | Monthly premium days | If there are missing premium days in the month, the reason (One or more of the reasons listed on the back page will be written in this section). |
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| The number of unemployment insurance premium payment days in this workplace in the last three years: |
| 5-DECLARATION PROCEDURES |
| The İŞKUR unit where the declaration will be submitted: |
| Date of issue (day/month/year): | Date of notification to the insured (day/month/year): |
| I accept that all the information in this declaration is complete and correct, and in case of any incorrect or incomplete information, I accept that I will be responsible for any liability that may arise from unfair and excessive payments to be made by the Institution. | With this declaration approved by the workplace and official identity document I know that I have to apply to the İŞKUR unit listed in section 5 within 30 days after the date of leaving the job. |
| | EMPLOYER/AUTHORIZED REPRESENTATIVE Name/Surname/Title/Signature/Stamp | | | INSURED Name, Surname, Signature |
