Annex 4

Mark Jones

National Insurance number: AB778899C

1.	My commitment

I’ll do everything I can to get paid work, and will receive Universal Credit payments to support me in this. The things I’ll do are set out in this Claimant Commitment.

2.	Finding and taking work

I’ll look for and take any work I’m able to do, that:

pays 6:19 an hour or more

is within 90 minutes' travel from my home

I can start work after 28 January 2013.

3. Changes in my circumstances

I’ll tell Universal Credit immediately about any changes in my circumstances that could affect my claim.

If I’m in paid work at any time, I’ll tell Universal Credit if my job ends, within 5 days of leaving. I must make sure all my earnings are reported to Universal Credit, either by me or by my employer.

If, without good reason, I leave paid work or lose pay, either by choice or because of misconduct, my Universal Credit payments could be cut by £10.20 a day for up to 3 years.

If, without good reason, I don’t tell Universal Credit within 5 working days that I’ve left a job, my Universal Credit payments will be cut by £10.20 for each further day that I don’t tell Universal Credit I’ve left that job. Once I’ve done this, my payments will be cut by £10.20 a day for a further period of up to 28 days.

If I also have earnings from self-employment at any time, I’ll tell Universal Credit the details of my self-employed income and expenses. I’ll do this each month through the Universal Credit phone service. I’ll be told what date I have to do this by each month, and I won’t get my Universal Credit payments until I’ve done it. If I still haven’t reported my self-employed income and expenses one month after this deadline, my Universal Credit claim will be stopped.

I must give Universal Credit information that I believe is correct and complete. I understand that if I don’t report any changes that affect my Universal Credit claim as soon as possible, I may be prosecuted or other action may be taken against me. I also understand that I may have to pay a £50 penalty if there is an overpayment of Universal Credit to me and it was my fault.

4. Meeting my commitment

Jobcentre Plus will give me help and advice to support me in doing the things set out in my Claimant Commitment. I know how to contact my Jobcentre Plus.

I’ll phone Universal Credit in advance on 0845 600 0723 if I can’t attend an appointment when I should.

If I don’t meet all the requirements set out in my Claimant Commitment, I understand that my Universal Credit payments will be cut. The number of days they’re cut for will depend on:

how many times I haven’t met my requirements in the previous 12 months

which requirements I haven’t met

I understand that the sanction rates for Universal Credit may change from time to time. The current rates at any given time will automatically apply to this Claimant Commitment.

If there is any doubt about my claim it will be reviewed, which could lead to my Universal Credit payments being reduced or stopped. If a decision is made to reduce or stop my payments, this will be explained to me. If I disagree with the decision, I have the right to have it reconsidered or to appeal against it.

Signature………………………………………………Date…………………………