Ni 65 Form PDF Details

Ensuring the continuous provision of benefits for its recipients, the National Insurance Board's NI 65 Life Certificate plays a crucial role. To be submitted biannually by mid-June and mid-December, this document seeks to affirm the ongoing life status of beneficiaries receiving various forms of assistance, such as retirement, invalidity and disablement pensions, survivors' benefits, and employment injury death benefits. Carefully divided into two main sections, the form calls for detailed beneficiary particulars—including name, address, national insurance and benefit numbers, and banking details—in Section "A". Meanwhile, Section "B" obligates a trustworthy declarant to certify the beneficiary's status, underpinned by solid identification markers like passports and driver's permits. Recognizing the form's importance in warding off any disruptions in payment, it prescribes a straightforward yet comprehensive verification mechanism for residents both within and outside Trinidad and Tobago, involving respected community members and officials. This structured approach underscores the commitment to maintain the integrity of the benefits system, while also addressing the practicalities of confirming beneficiaries' circumstances and ensuring rightful disbursement of aid.

QuestionAnswer
Form NameNi 65 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesni 65 forms trinidad, nibtt, ni82 form, ni 82

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THE NATIONAL INSURANCE BOARD

NI 65

LIFE CERTIFICATE

 

PLEASE RETURN THE COMPLETED FORM TO YOUR LOCAL OFFICE OR VISIT YOUR LOCAL OFFICE BY MID-JUNE AND MID-DECEMBER OF EACH YEAR TO ENSURE THAT PAYMENTS CONTINUE

SECTION "A" - PARTICULARS OF BENEFICIARY (To be completed by Beneficiary)

NAME:

SURNAME:

 

NATIONAL INSURANCE NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER NAME(S)

ADDRESS:

BENEFIT NUMBER (Where applicable)

TELEPHONE NUMBER:

TYPE OF BENEFIT:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

--

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF BANK/CREDIT UNION:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ACCOUNT NUMBER:

ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The information given above

is/

is not different from that previously given.

*Re: Spouse/Parents Benefit - I have/have not remarried.

 

 

 

*Date of marriage if applicable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YYYY

 

MM

DD

 

 

 

*Applicable to survivors and death benefits only.

 

 

 

 

 

 

 

Declared this

 

day of

 

 

 

 

 

 

 

20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE OR MARK OF CLAIMANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION "B" - CERTIFICATE OF DECLARATION (To be completed by Declarant) (See list overleaf)

I

PLEASE PRINT

of

PRESENT ADDRESS

declare that on

Mr/Mrs/Miss

PASSPORT

YYYY MM DD

DRIVER'S PERMIT

was alive and produced Identification in the form of:

ELECT I. D.

NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

I make this declaration conscientiously believing same to be true and I am aware I am subject to the process of law for any false or misleading information given.

Declared this

 

day of

 

20

 

 

SIGNATURE OF DECLARANT:

PROFESSION/RANK:

IDENTIFICATION OF DECLARANT:

PASSPORT

DRIVER'S PERMIT

ELECT I. D.

NUMBER:

OFFICIAL STAMP

(if any)

OTHER (Please specify)*below

*IDENTIFICATION

2/NI 65

INSTRUCTIONS FOR USE OF LIFE CERTIFICATE

(The purpose of the Life Certificate is to establish that the

beneficiary is alive on the date of this Declaration)

1.All Recipients of National Insurance Retirement, Invalidity and Disablement Pensions, Survivors Benefits and Employment Injury Death Benefits must complete this LifeCertificate every six months.

2.The Declaration may be signed by:

(a)(For a resident of Trinidad and Tobago)

any Magistrate, Justice of the Peace, Clergyman, Warden, Councillor/Assemblyman, Bank Manager, Medical Practitioner, Attorney-at-Law, Principal/Vice Principal of any Government/approved School, Head of any Government Institution or any Police/Military officer of the rank of Sargeant and above or Local Office Staff or Supervisory Officer of the National Insurance Board.

(b)(For a non-resident of Trinidad and Tobago)

a member of the Trinidad and Tobago Mission in the Country in which the Beneficiary is a resident OR an Attorney-at-Law, OR a Notary Public, OR a Justice of the Peace OR a Medical practitioner.

3.Identification produced by the beneficiary should be a valid form of one of the following: Passport, Driver's Permit or Electoral Identification Card.

4.You are required to submit a BANK ACCOUNT NUMBER as provided for on this Form.

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