19. Where an employee has an interruption in earnings in connection with a pregnancy, a birth or an adoption, the employer must provide the following information using the information statement form made available by the Minister which will be used to establish the employee’s entitlement to benefits:(1) the employer’s name, address and telephone number;
(2) where applicable, the employer’s business number in Québec obtained from the enterprise registrar;
(3) the employee’s name, address and social insurance number;
(4) the date on which the employee’s earnings were interrupted and the reasons therefor;
(5) the dates of the first and last days of paid work;
(6) the end date of the last pay period;
(7) the total insurable earnings during the 52 weeks preceding the interruption of earnings and, where applicable, during the qualifying period as extended;
(8) the frequency of the pay periods during the 52 weeks preceding the interruption of earnings and, for each, the amount of the employee’s insurable earnings, allocated in accordance with section 26.1;
(9) any pay period without earnings;
(10) any amount payable to the employee after the last payday and the reason for the payment;
(11) any amount paid to the employee as salary insurance; and
(12) the name of the person to contact for more information.