Form NI 165
Insured Person Data Update
View Instructions
Clear Form
1. Name
First Name
Middle Names (if any)
Surname
2. If known by any other names, please state
First Name
Middle Names (if any)
Surname
3. Address
Street Address
City / District / County
Postal Code
4. Email Address
5. Telephone Number
Home
Phone
Cell
Phone
6. National Insurance Number
7. Have you ever used any other N.I Number(s)?
Yes
No
8. Gender
Male
Female
9. Date of Birth
10. PIN (Electronic Birth Certificate No.)
11. Valid Indentification
Electoral Identification Card
Passport
Driver's Permit
12. Marital Status
-- select an option --
Single
Married
Divorced
Widowed
13. Father's Name
First Name
Middle Names (if any)
Surname
14. Mother's Maiden Name (Surname)
15. Date of First Employment
16. Employment History
Please state exact address e.g. Mile Mark, Light Pole Number
Employer
Address
Type
Start Date
End Date
Occupation
Add Employment History
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