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NATIONAL INSURANCE FORMS

Unemployment Benefits Form
unemployment Declaration form
CONTRIBUTORY OLD-AGE PENSION FORM
NON-CONTRIBUTORY OLD-AGE PENSION FORM
Claim for Disablement Form
Funeral Grant
Termination of Service Form

Claim for Disablement

  • Date Format: DD slash MM slash YYYY
  • DETAILS OF ACCIDENT

  • Date Format: DD slash MM slash YYYY
  • :
  • Name of HospitalState whether in-patient or out-patientName of ward if in-patientHospital reference of admission no.Date (from and to) 
  • ALTERNATE PAYEE DETAILS

    To be completed if payment is to be made to someone on your behalf
  • BANKING DETAILS

    To be completed where payment of this claim is to be deposited to a bank account.
  • I hereby authorise payment in respect of this benefit to be lodged to the bank account given below.
  • Please provide proof of bank account - The header of a bank statement of a stamp from your bank verifying your account details.
  • DECLARATION

  • I hereby declare that the information given on this form is true to the best of my knowledge and belief.
  • Date Format: MM slash DD slash YYYY
  • If you are unable to sign this application, it may be signed of your behalf by someone who should state that they have done so.
  • WARNING - Any person who makes a false statement or any false representation for the purpose of obtaining benefit, commits a crime punishable by a fine or a term of imprisonment or both.
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Employees

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  • Registration
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Self-Employed

  • Sickness Benefits
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  • Invalidity Grant/Benefit

Pensioners

  • Old-Age Contributory Benefit
  • Non-Contributory Old-Age benefit
  • Frank Walcott Building, Culloden Road, Bridgetown
  • 467-4NIS (4647)
  • customer.service@bginis.gov.bb

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