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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 FUNERAL GRANT

Please complete all relevant sections. Failure to do so may delay the processing of this claim.

All applications MUST be accompanied by ORIGINAL documents.

  1. Original Death Certificate of the deceased insured person
  2. A receipt for the funeral expenses paid by the claimant or funeral director’s invoice for outstanding funeral expenses.
  3. Original Marriage Certificate.

Notes: For applicants residing overseas, please provide notarized copies of the documents listed above. If there are uncashed cheques related to the deceased, these cheques MUST be returned to the National Insurance Office immediately. This claim should be submitted within 12 months of the date of death. Written authorization must be provided if benefit is being paid to the funeral home or alternative payee.

Claim for Funeral Grant

  • DETAILS OF THE DECEASED

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

    (Married or Common Law)
  • Date Format: DD slash MM slash YYYY
  • TO BE COMPLETED IF CLAIMANT WAS NOT MARRIED TO THE DECEASED.
  • DETAILS OF CLAIMANT

  • Date Format: DD slash MM slash YYYY
  • BANKING DETAILS

    If payment is to be deposited to a bank account
  • I hereby authorise payment in respect of this benefit to be lodged in the bank account given below.
  • Please provide proof of bank account - The header of the bank statement or an official stamp from your bank verifying your account details.
  • ALTERNATE PAYEE DETAILS

    If payment is to be made to someone on your behalf
  • Date Format: DD slash MM slash YYYY
  • UNDERTAKING TO PAY FUNERAL EXPENSES - TO BE COMPLETED ONLY WHEN AN INVOICE FROM THE FUNERAL DIRECTOR IS SUBMITTED.
  • (a) I am the person entitled to make a claim for the funeral grant
    (b) I am liable to the National Insurance to pay the sum for and towards the cost of the funeral of the deceased
  • Date Format: DD slash MM slash YYYY
  • Drop files here or
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  • Old-Age Contributory Benefit
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