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Rrb. gov. UB-11 03-12 Base Year Benefit Year Only qualified employees can receive benefits under the Railroad Unemployment Insurance Act. 2. Complete this statement by following the instructions in the UB-11 booklet under Instructions for Completing Forms Statement of Authority to Act for Employee SI-10. Signing this statement gives you the authority to sign any claim forms on behalf of the employee. When signing claim forms use your full name a.

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