Form B.75b - Continuing Eligibility To Receive A Benefit

Form B.75b - Continuing Eligibility To Receive A Benefit - Nib

P. O. Box N-7508

Nassau, Bahamas

Tel: (242) 502-1500

Fax: 322-3048

CONTINUING ELIGIBILITY TO

RECEIVE A BENEFIT

IMPORTANT NOTE:

Any person who, for the purpose of obtaining a Benefit under Section 49(5) Chapter 350 Statute Laws of

The Bahamas, either for himself or for some other person, knowingly makes false statements or submits

false documents, shall be liable to a fine not exceeding $2,500 or to imprisonment for up to twelve months

or both.

FOR OFFICIAL USE ONLY

PENSIONER: _____________________________________________________________________

Surname

First Name

Other Name(s)

N.I. #:

TELEPHONE ___________________________

ADDRESS: _______________________________________________________________________

Street

City /Settlement

P. O. BOX/AREA CODE _________________________ CLAIM NUMBER: ________________

BENEFIT: ______________________ BANK: ________________

ACCOUNT # ___________

COMPLETE IF YOU MOVED SINCE YOUR LAST VERIFICATION

ADDRESS:

House /Apt.#

Street

P.O. Box:

Island/State

Country

TELEPHONE NO._____________________ (H)

_____________________ (W)

PLEASE NOTE:

Every Pensioner must notify the Director in writing as soon as practicable after the occurrence of any

change of circumstances that may affect his right to Benefit or to the receipt thereof.

Any Pensioner who, without good cause, fails to notify the Director of such Change of Circumstances will

be guilty of an offence and would be liable on summary conviction to a fine not exceeding one hundred

dollars, ($ 100.00).

A change of circumstance may affect a Pensioner’s entitlement to Benefit.

Although a Pensioner was awarded Benefit, he can be disqualified from further receipt of Benefit/Assis-

tance if his circumstances change.

Payment of Benefits will be suspended if a pensioner fails to produce evidence of his continuing eligibility for such

payments.

(Complete Only the Section (s) That Applies to You)

Retirement Benefit Verification

1. Are you:

Employed

Self-employed

Unemployed

2. If Employed/Self-employed, how much do you earn Weekly: $_____________/ Monthly: $_____________

Employer’s Name: _________________ Address: ___________________ Tel: ________________

Invalidity Benefit Verification

1. Are you:

Employed

Self-Employed

Unemployed

B.75b

Form B.75b - Continuing Eligibility To Receive A Benefit - Nib

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