Appeals Commission – Application for Interim Relief for Workers
Page 2 of 4 EXT07a (20210401)
Effective April 1, 2021
Section 3: Application for interim relief continued
Is the worker, spouse or adult interdependent partner ineligible for any other financial support? Please include
documents to support your answer. These can include documents that show you, your spouse or partner are
not able to get financial support, like money or benefits, from anywhere else. For example, a document from a
government agency or organization which provides money or other benefits to people, like Employment
Insurance, Assured Income for the Severely Handicapped or Income Support.
Without interim relief, would the worker and his/her family be placed in necessitous circumstances such as
probable inability to afford basic necessities of life such as food, clothing and shelter, or face probable
forfeiture or seizure of assets (for example, the family home)? Please include documents to support your
answer. These documents can include:
• Financial records such as bank and credit card statements.
• Documents showing information about mortgage, rent or lease payments and about your ability to make the
payments.
• A monthly income and expense statement. This includes a list of how much money you receive each month
and from where. It also includes a list of how much money you spend each month and what you spend it on.
