Form NI 4
Application to Register as an Employed Person (Other than Self-employed)
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Clear Form
1. Name
First Name
Middle Names (if any)
Surname
2. Name at birth if different from above (Changed by Deed Poll, Marriage)
First Name
Middle Names (if any)
Surname
3. Other names by which known
First Name
Middle Names (if any)
Surname
Telephone Number
Phone
4. Are you an apprentice?
5. Gender
Yes
No
Female
Male
6. Home Address
Street Address
City / District / County
7. Date of Birth
8. Place of Birth
Street Address
City / District / County
9. Multiple Birth
Yes
No
10. Family members with same name?
Yes
No
11.Father's Name
First Name
Middle Names (if any)
Surname
12. Mother's Maiden Name
13(a). Valid Identification Document
Electoral Identification Card
Passport
Driver's Permit
13(b). Expiry Date
14. Marital Status
-- select an option --
Single
Married
Divorced
Widowed
Common Law
Separated
15. If Marital Status is Common Law, please give particulars of Common Law Spouse
Name of Common Law Spouse
First Name
Middle Names (if any)
Surname
16. Business name of Employer
17. Address of Employer
Street Address
City / District / County
18. Occupation
19. Pay Frequency
Daily
Weekly
Fortnightly
Monthly
20. First Date of Employment
21. Have you been previously registered?
Yes
No
22. Are you currently employed elsewhere?
Yes
No
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