Fillable Form B.58 - Claim For Retirement Benefit printable pdf download

THE NATIONAL INSURANCE ACT, 1972

THE NATIONAL INSURANCE BOARD

OF THE COMMONWEALTH OF THE BAHAMAS

DATE OF RECEIPT

BY HAND

BY POST

CLAIM FOR RETIREMENT BENEFIT

IMPORTANT NOTES

1. Full Retirement Benefit is payable from age 65 years, but a reduced benefit may be paid from age 60 years. A claim should

be submitted as soon as possible after retirement, but not earlier than three months before reaching “retirement” age.

2. Some benefit may be lost if a claim is submitted more than six months after the actual date of retirement (if the claimant is

age 60 years or older at the time of retirement).

3. Forms should be brought or mailed to any one of the Board’s Local Offices. Claim forms should be accompanied by:

a) A birth certificate, affidavit or passport; and

b) The National Insurance Identification card; and (in the case of an employed person)

c) A letter from the employer stating the date of retirement.

4. Once benefit payments commence, pensioner will be required to present kimself/herself for verification, or (in the case of

those abroad) to produce notarized evidence of continuing eligibility for the benefit, at least twice each year - in his/her

birth month and six months thereafter. Failure to do so, will result in the suspension of further payments.

DETAILS OF APPLICANT

1. SURNAME ________________________________ 2. OTHER NAME(s) ______________________

3. STREET ADDRESS _____________________________________________________________________

4. E-MAIL _______________________________________________________________________________

5. TELEPHONE ______________________________ 6. P. O. BOX ______________________________

7. DATE OF BIRTH: _____/_____ /_____

8. N.I. No.

day

month

year

9. PRESENT (or last) EMPLOYER __________________________________________________________

10.EMPLOYER’S P. O. BOX _________________

11. EMPLOYER’S TELEPHONE ____________

12.DATE OF RETIREMENT: Day _______________

Month ______________ Year ______________

PAYMENT

Please be reminded: A reduced Benefit will be paid if you choose to claim before you reach age 65 years.

1. DO YOU WISH PAYMENTS TO COMMENCE FROM CLAIM DATE? Yes

2. IF “NO”, WHEN:______________________________________

Recipients of Retirement Benefit (with the exception of persons who live on Bahamian islands where there are no

banks) are required to have their monthly payments sent to the banks of their choice (in The Bahamas). Persons

who live on islands where there are no banks, may collect their monthly cheques from their nearest local office.

Please provide information on where you want your cheques to be sent:

3. PAYSTATION INFORMATION (for claimants on Family Islands with no banks, only)

Local Office: ____________________________________________________________________________

4. BANK INFORMATION:

Bank ________________________ Branch: _________________

Account # ___________________

DECLARATION AND CLAIM

I DECLARE that the particulars given by me and recorded in this claim are true to the best of my knowledge and

belief.

I CLAIM Retirement Benefit under the National Insurance Act, 1972, and I undertake that if a pension is

awarded I shall inform the National Insurance Board of any change in my circumstances which may affect my

entitlement to the pension.

Signature (or Mark) of Pensioner _________________________________ Date _____________________

Witness to Mark if claimant is unable to sign: __________________________________________________

Form B.58

Form B.58 - Claim For Retirement Benefit

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