NI Forms - Trinidad and Tobago

NI forms for the range of NIS benefits and other National Insurance Business transactions in Trinidad and Tobago, CARICOM countries and Canada.

Please view the Benefit Claims Guidelines & Checklist below when completing your claim.


NI 200 - Compliance Certificate Application

Registration - Employers and Employees

NI 1- Register as an Employer
NI 4 - Register as an Employed Person
NI 33 - Request for Replacement National Insurance Cards
NI 184- Statement of Contributions Paid/Due (Please use original legal sized paper)
NI 187 - Statement of National Insurance Contributions Due/In Arrears
Termination Certificate

Employment Injury Benefits

NI 19 - Employment Injury Benefit Application
NI 19A - Employment Injury Benefit Follow-Up Medical Certificate
NI 34A - Child Allowance - Medical Report
NI 114 - Medical Expenses Claim
NI 117 - Death Benefit Claim
NI 119 - Disablement Benefit Claim

Invalidity Benefit

NI 38 - Invalidity Benefit Application

Maternity Benefit and Special Maternity Grant

NI 12- Maternity Benefit Application
NI 12A - Multiple Births
NI 13 - Special Maternity Grant Claim

Sickness Benefit

NI 15 - Sickness Benefit Application
NI 15A - Sickness Benefit Follow-Up Medical Certificate

Retirement Benefit / Grant

NI 82 - Retirement Benefit Application

 Funeral Grant

NI 8 - Funeral Grant Claim

Survivors Benefits

NI 51- Survivor Benefit Application
NI 34A - Child Allowance - Medical Report

 Voluntary Insurance

NI 6 - Certificate of Voluntary Insurance Application
NI 11 - Voluntary Contributor Record Card


NI 42 - Nomination of Spouse
NI 79 - Application for Refund
NI 183 - Request for Statement of Contribution
NI 99 - Complaint Form
NI 165 - Insured Person Data Update Questionnaire
NI 184A - Benefit Payment Authorisation
NI 165 - Pension Ready Insured Person Data Update Questionnaire
NI 182 - Change of Particulars of the Insured Person
NI 65 - Life Certificate


Use of National Insurance Forms
Whenever you perform National Insurance functions under the National Insurance Act or Regulations, you must accurately complete the specific National Insurance forms that are designed so that you can give all the information required.

All these forms are available FREE of charge at ny National Insurance Service Centre or are downloadable