Form Fg.1 - Claim For Funeral Grant - Social Security Board - 2013 Page 2
Download a blank fillable Form Fg.1 - Claim For Funeral Grant - Social Security Board - 2013 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Fg.1 - Claim For Funeral Grant - Social Security Board - 2013 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2PART III. DOCUMENTS TO bE PROvIDED
Note: (a - d) applies to all claims for Funeral Grant in addition to (e - g) or (h & i), whichever applies
(a) Original Death Certificate of the Deceased Person, and
(b) Original Receipts for the funeral expenses in the applicant’s name who paid for the funeral expenses; or
(c) Original Invoice or Pro-Forma in the applicant’s name who is liable to pay for the expenses, and
(d) Social Security Registration Card of the Deceased Person (if available), and
FOR DEPENDENT CHILDREN
(e) Birth Certificate of Dependent Child (if a Registration Card is not available), and
(f) Proof of Education (a letter from the school) if Dependent Child is over 16 years and receiving full time education
(g) Still Birth Notification Form issued by the Ministry of Health at public hospital/clinics
FOR SPOUSE/COMMON-LAW UNION
(h) Original Marriage Certificate; or
(i) A declaration from a Justice of the Peace for common-law union attesting to the relationship
I declare that the information given above is true to the best of my knowledge.
________________________
__________________________________
_______ /_______ /_______
SIGNATURE
ClAImANT’S FUll NAmE IN PRINT
DAY
mONTH
YEAR
NOTE: If you are unable to sign this claim, it may be signed on your behalf by someone who should state that he or she
has done so.
FOR OFFICIAL USE ONLY
Decision on Funeral Grant Claim
Allowed
Disallowed
If disallowed, state the reasons for disallowance: ___________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Amount of Grant: $___________________ Cheque Number: ______________________ Date: ______/______/______
DAY
mONTH
YEAR
Amount of Deductions: $_________________ Receipt Number: ____________________ Date: ______/______/______
DAY
mONTH
YEAR
Please indicate reasons for deductions from grant, if any: ____________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Claim Processing
Processing Officer: __________________________________
____________________
______/______/______
NAmE IN PRINT
SIGNATURE
DAY
mONTH
YEAR
Authorizer (AA/ADMIN): ____________________________
____________________
______/______/______
NAmE IN PRINT
SIGNATURE
DAY
mONTH
YEAR
Relevant Notes:
___________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Form FG.1 (August 2013)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal