Claims Checklist

FUNERAL GRANT

  • COMPLETED CLAIM FORM - NI 8
  • DEATH CERTIFICATE OF INSURED
  • RECEIPT – bearing the name of the person (the applicant) who has stood the expenses for the turnout and referencing the name of the deceased
  • NATIONAL INSURANCE REGISTRATION CARD OF THE DECEASED (if available)

 

SICKNESS BENEFIT

  • COMPLETED CLAIM FORM – NI 15 (First claim)
  • NI 15A (CONTINUATION CLAIM)
  • BIRTH CERTIFICATE (IF APPLICANT IS AGE 60+)
  • AFFIDAVIT/DEED POLL/MARRIAGE CERTIFICATE IF NECESSARY (Name not on Birth Certificate, Name different to what is on birth certificate)

 

MATERNITY BENEFIT

  • COMPLETED CLAIM FORM – NI 12 

 

SPECIAL MATERNITY BENEFIT

  • COMPLETED CLAIM FORM - NI 13
  • AFFIDAVIT FROM BOTH PARENTS (IF COMMON LAW RELATIONSHIP)
  • MARRIAGE CERTIFICATE

 

INJURY BENEFIT

  • COMPLETED CLAIM FORM - NI 19
  • NI 19A (Continuation medical where applicable)

 

MEDICAL EXPENSES

  • COMPLETED CLAIM FORM – NI 114
  • RECEIPTS OF EACH EXPENSE BEING CLAIMED
  • REFERRAL LETTER FROM DOCTOR (If referred to another provider e.g. Chiropractor, Physiotherapist etc.)

 

DISABLEMENT BENEFIT

  • COMPLETED CLAIM FORM – NI 119
  • STATEMENT FROM EMPLOYER IN RESPECT OF ACCIDENT IF INJURY BENEFIT WAS NOT CLAIMED

 

RETIREMENT BENEFIT

  • COMPLETED CLAIM FORM – NI 82
  • BIRTH CERTIFICATE (Electronic)
  • AFFIDAVIT (Where necessary)
  • MARRIAGE CERTIFICATE (Female applicant)
  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • DEED POLL (If applicable)
  • ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)

 

INVALIDITY BENEFIT

  • COMPLETED CLAIM FORM –NI 38
  • BIRTH CERTIFICATE (Electronic)
  • AFFIDAVIT (Where necessary)
  • DEED POLL (If applicable)
  • MARRIAGE CERTIFICATE (Female applicant)
  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)

 

SURVIVOR

COMPLETED CLAIM FORM – NI51 (Claim form is the same for each category)

BIRTH CERTIFICATE OF APPLICANT (Electronic

AFFIDAVIT (Where necessary)

  • DEED POLL (If applicable)
  • MARRIAGE CERTIFICATE (Female applicant)
  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)

 

SURVIVOR (COMMON LAW)

  • COMPLETED CLAIM FORM – NI51 
  • BIRTH CERTIFICATE OF APPLICANT (Electronic
  • AFFIDAVIT (Where necessary)
  • DEED POLL (If applicable)
  • SELF SWORN DECLARATION FROM APPLICANT
  • DECLARATIONS FROM THREE PROMINENT PERSONS TO ESTABLISH KNOWLEDGE OF THE PARTIES COHABITING

If previously married, then -

  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)

If deceased was previously married, then –

  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)

CHILD ALLOWANCE

  • COMPLETED CLAIM FORM – NI 51
  • CHILD’S BIRTH CERTIFICATE
  • AFFIDAVIT WHERE NECESSARY
  • PROOF OF PATERNITY WHERE NECESSARY
  • MEDICAL CERTIFICATE IF DISABLED

 

ORPHAN’S ALLOWANCE

  • COMPLETED CLAIM FORM - NI 51
  • Death Certificate of both parents (if both were insured persons)
  • BIRTH CERTIFICATE OF ORPHAN
  • AFFIDAVIT WHERE NECESSARY
  • PROOF OF PATERNITY WHERE NECESSARY
  • MEDICAL CERTIFICATE IF DISABLED

DEPENDANT PARENT

  • COMPLETED CLAIM FORM - NI 51
    • Birth certificate of the deceased (Affidavit if father’s name is not on deceased’s birth certificate)
  • AFFIDAVIT OUTLINING EXPENSES AND CONTRIBUTION OF THE DECEASED
  • PROOF OF DECEASED’S CONTRIBUTION TO PARENTS’ UPKEEP (BILLS AND RECEIPTS)

DEATH BENEFIT

  • COMPLETED CLAIM FORM– NI117 (Claim form is the same for each category)
  • BIRTH CERTIFICATE OF APPLICANT (Electronic
  • AFFIDAVIT (Where necessary)
  • DEED POLL (If applicable)
  • MARRIAGE CERTIFICATE (Female applicant)
  • DECREE ABSOLUTE OF DIVORCE (Where applicable)

 

DEATH BENEFIT (COMMON LAW)

  • COMPLETED CLAIM FORM – NI117
  • BIRTH CERTIFICATE OF APPLICANT (Electronic)
  • AFFIDAVIT (Where necessary)
  • NOMINATION OF SPOUSE (NI 42 Where applicable)
  • DEED POLL (If applicable)
  • SELF SWORN DECLARATION FROM APPLICANT
  • DECLARATIONS FROM THREE PROMINENT PERSONS TO ESTABLISH KNOWLEDGE OF THE PARTIES COHABITING

If previously married, then -

  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)

If deceased was previously married, then –

  • DECREE ABSOLUTE OF DIVORCE (Where applicable)
  • Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)

CHILD ALLOWANCE

  • COMPLETED CLAIM FORM – NI 117
  • CHILD’S BIRTH CERTIFICATE
  • AFFIDAVIT WHERE NECESSARY
  • PROOF OF PATERNITY WHERE NECESSARY
  • MEDICAL CERTIFICATE IF DISABLED

DEPENDANT PARENT

  • COMPLETED CLAIM FORM – NI 117
  • BIRTH CERTIFICATE OF THE DECEASED (AFFIDAVIT IF FATHER’S NAME IS NOT ON DECEASED’S BIRTH CERTIFICATE)
  • AFFIDAVIT OUTLINING EXPENSES AND CONTRIBUTION OF THE DECEASED
  • PROOF OF DECEASED’S CONTRIBUTION TO PARENTS’ UPKEEP (BILLS AND RECEIPTS)

 

ALL CLAIMS

  • IF POSTAL – PROOF OF ADDRESS (Utility bill)
  • IF FINANCIAL INSTITUTIONS - PROOF OF FINANCIAL INFORMATION
  • IDENTIFICATION DOCUMENT OF APPLICANT (Valid document - EID CARD, PASSPORT, DRIVER’S PERMIT
  • IDENTIFICATION DOCUMENT OF THIRD PARTY – WHERE APPLICABLE (Valid document - EID CARD, PASSPORT, DRIVER’S PERMIT)

 

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National Insurance Board of Trinidad and Tobago (NIBTT)