MINISTRY OF LABOUR AND SOCIAL SECURITY
FORM R2
APPLICATION FOR NATIONAL INSURANCE NUMBER
This Form is to be completed using BLOCK LETTERS.
Bring supporting documents* to verify
FOR D.P. USE ONLY
(i)
Birth Date
(ii)
Marriage Date
National Insurance Number
(iii)
Spouse’s Date of Birth
Parish
YOB
Sex
SI
No
All dates must be entered in the format year, month, day
(YYYYMMDD) e.g. Date of Birth:- 1969/12/25
1.
.
Applicant’s Name
Do NOT write in the boxes immediately below shaded area
Surname
First Name
Middle Name
Maiden/Other Name (if any)
TRN Number
Sex (Tick ( √ ) the appropriate box)
2.
3.
Date of Birth
FOR OFFICIAL USE ONLY
Y
M
D
Male
* Verified by:
Passport No.
____________
Birth Cert.
____________
Female
Baptismal Cert. ____________
School Record ____________
4.
Address of Applicant
Street Name/District
Lot/ Apartment Number
Post Office/Postal Agency
Code
Parish Name
e
Cod
5.
Country of Birth
6. Nationality
Name of Country
Code
Nationality
Code
7.
8
?
Applicant’s Occupation
. Are you self employed
Occupation
Code
Y/N
. Marital Status (Tick ( √ ) one (1) of the boxes below)
9
10.
under
Have you ever registered
NIS?
If ‘yes’ give NIS NUMBER
Single
Common-law
Married
Divorced
Widowed
Separated
Code
NIS NUMBER
*
Birth Certificate, Baptismal Certificate, Passport Number.