Claim for Old-age Pension

NATIONAL INSURANCE FORMS

CLAIM FOR CONTRIBUTORY OLD-AGE PENSION FORM

Required documents

Barbados Identification Card
Original Birth Certificate
Original Marriage Certificate
Original Decree Absolute – if divorced
An affidavit for non-contributory pension

For applicants resident outside of Barbados, please provide notarized copies of the above listed documents.

Timeline Pensionable age

January 1, 2014 to December 31, 2017 66 ½

January 1, 2018 and after 67

Claim for Old-age Contributory Pension

PERSONAL DETAILS
National Insurance Number*
National Registration Number*
Name
First Middle Last
Address
District
Parish
Zip/Postal Code
Date of Birth
Date Format: DD slash MM slash YYYY
Tel. No.
Cell No.
Email
RETIREMENT DETAILS
Please tick the box with represents your choice.
- I hereby apply for pension at the standard pensionable age
- I hereby apply for early retirement pension on
- I hereby apply to defer my pension to
Date
Date Format: DD slash MM slash YYYY
Date
Date Format: DD slash MM slash YYYY
EMPLOYMENT DETAILS
Name of current or last employer
Date of Retirement
Date Format: DD slash MM slash YYYY
Are you a director of a company?
- Yes
- No
EMPLOYMENT HISTORY
Indicate the year in which you first paid NIS contributions
Have you ever worked as a self-employed person in any other country outside of Barbados?
- Yes
- No
List
Country From (date) To (date) Social Security Number (overseas)
ALTERNATE PAYEE DETAILS
To be completed if payment is to be paid to someone on your behalf
National Insurance Number
National Registration Number
Name
First Middle Last
Address
District
Parish
Zip/Postal Code
Date of Birth
Date Format: DD slash MM slash YYYY
Tel. No.
Cell No.
Email
BANKING DETAILS
To be completed if payment is to be deposited on a bank account.
I hereby authorise payment in respect of this benefit to be lodged in the bank account give below.
Name(s) on account
Account Number
Name and Location of Branch
Please provide proof of bank account - The header of the bank statement or an official stamp from your bank verifying your account details. For overseas pensioners, please provide the relevant banking codes.
Declaration*
I hereby declare that the information given on this form is true to the best of my knowledge and belief.
Signature*
Date*
Date Format: MM slash DD slash YYYY
Upload relevant documents here.
Drop files here or
WARNING: Any person who knowingly makes a false statement or false representation for the purpose of obtaining benefits, commits a criminal offence punishable by a fine or a term of imprisonment or both.

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NATIONAL INSURANCE FORMS

CLAIM FOR CONTRIBUTORY OLD-AGE PENSION FORM

PERSONAL DETAILS

RETIREMENT DETAILS

EMPLOYMENT DETAILS

EMPLOYMENT HISTORY

ALTERNATE PAYEE DETAILS

BANKING DETAILS

Employees

Unemployed

Employers

Self- employed

Pensioner

Contribution

Employees

Unemployed

Employers

Self-Employed

Pensioners

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Country	From (date)	To (date)	Social Security Number (overseas)