Nib Self Employed Registration Application Form – Fill Out and Use This PDF

The Nib Self Employed Registration Application form is a crucial document for individuals seeking to register as self-employed under the National Insurance Board's regulations. It requires detailed personal information, employment data, and a declaration to be completed accurately to ensure proper recording of national insurance contributions and the swift processing of any claims. For those looking to navigate through the complexities of self-employment registration, filling out this comprehensive form is the first critical step.

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Nib Self Employed Registration Application Form PDF Details

Understanding the Nib Self-Employed Registration Application form is essential for anyone looking to register as an employed individual, a step differentiated from self-employed registration. This detailed document, governed by the National Insurance Board under the National Insurance Registration Regulations, outlines the necessity for employers to register their employees, including apprentices, within a 14-day timeframe to avoid possible fines. It emphasizes the importance of providing complete and accurate personal information to ensure the correct recording of national insurance contributions and the efficient processing of claims. The form requires a variety of information from basic personal details, employment particulars, to a declaration to be signed by both the applicant and the employer, emphasizing the accuracy and veracity of the information provided. Late or incomplete registrations can lead to complications; hence, understanding each section of the application, from personal identification to employment details and the legal requirements for declarations, plays a key role in a seamless registration process. This introduction aims to guide individuals through the essential aspects of the form, highlighting the importance of accuracy and timely submission in the registration process.

Question	Answer
Form Name	Nib Self Employed Registration Application Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	nis 184 form, ni 184 fillable form, nis forms ni 187, ni 184

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THE NATIONAL INSURANCE BOARD	NI 4
THE NATIONAL INSURANCE REGISTRATION REGULATIONS
APPLICATION TO REGISTER AS AN EMPLOYED PERSON
(Other than Self-employed)

INSTRUCTIONS

1.Please TYPE or complete in BLOCK LETTERS.

2.Employers must register employed persons and apprentices within 14 days of employment. Late registration could result in a fine.

3.The law requires that you furnish your employer with the personal particulars necessary to complete this form.

4.All questions must be answered: if you do not know your Father's name or Mother's maiden name, the words "not known" must be inserted on the respective lines.

5.Proper recording of your National Insurance Contributions and prompt and accurate settlement of your claims cannot be achieved if you do not provide the information required on this form.

6.Read the Declaration at the back carefully and sign in the space provided.

ALL INFORMATION MUST BE VERIFIED BY YOUR EMPLOYER

FOR OFFICIAL USE

LOCAL OFFICE NO.:

NATIONAL INSURANCE NO.:

Surname:

First Name:

Middle Name:

Name at birth if different from above: (Changed by Deed Poll, Marriage)

Surname:

First Name:

Other names by which known:

Surname:

First Name:

Telephone No.:

Are you an apprentice?

Yes

Gender:

Female

Male

Home Address:

STREET

CITY/DISTRICT/COUNTY

Date of Birth:

8. Place of Birth:

YYYY

STREET

Multiple Birth:

Yes

If "Yes", please state name of siblings.

CITY/DISTRICT/COUNTY

Surname:

Other Name(s):

Surname:

10. Any Family members with same name?

Yes

If "Yes", please state relationship and Date of Birth:.

Relationship:

Other Name(s):

Date of Birth:

YYYY MM DD

Date of Birth:

YYYY MM DD

01/2009

2/NI4

11.

Father's Name:

Surname:

First Name:

12.

Mother's Maiden Name:

13.

Valid Identification Document (one Only):

13b. Expiry Date:

Electoral Identification Card

Passport

Driver's Permit

YYYY

Number:

14.

Marital Status:

Single

Married

Separated

Widowed

Divorced

Common Law

15.If Marital Status is Common Law, please give particulars of Common Law Spouse: Name of Common Law Spouse:

Surname:

First Name:

16.

Business Name of Employer:

17.

Address of Employer:

					STREET
				CITY/DISTRICT/COUNTY
18.				19.	Daily
18.	Occupation:			19.	Pay Frequency:		$
					Weekly	Amount	$
					Weekly	Amount
20.	First Date of Employment:				Fortnightly
20.	First Date of Employment:
	YYYY	MM	DD		Monthly
21.	Have you been previously registered?	Yes		No	If "Yes", state N.I. Number:
22.	Are you currently employed elsewhere?	Yes		No
		Yes		No
	If "Yes", state Business Name and Address of Other Employer:
	Business Name of Employer:
	Address of Employer:
					STREET
				CITY/DISTRICT/COUNTY

CERTIFICATE OF DECLARANT

I solemnly and sincerely declare that I am the applicant named herein and that the particulars set out in this application are true. I make this declaration conscientiously believing same to be true and I am aware that if there is any statement in this declaration which is false in fact or which I know or believe to be false or do not believe to be true, I am liable on summary conviction to a fine of three thousand dollars ($3,000.00) and to imprisonment for two years in accordance with Sect 33, NI Act Chap 32:01.

Declared this

YYYY MM DD

Employer's Registration No:

Signature or Mark of Declarant

Signature or Witness to Mark

Was information verified by Employer?

Yes

COMPANY STAMP

SIGNATURE OF EMPLOYER

DESIGNATION

01/2009

Nib Self Employed Registration Application Form – Fill Out and Use This PDF

Nib Self Employed Registration Application Form PDF Details

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