Form NI 6
Certificate of Voluntary Insurance
View Instructions
Clear Form
Section A - To be completed by applicant
1. Name
First Name
Middle Names (if any)
Surname
2. Home Address
Street Address
City / District / County
3. National Insurance Number
4. Date of Birth
5. Gender
Male
Female
6. Valid Indentification
Electoral Identification Card
Passport
Driver's Permit
7. Date of Termination of Employment
8. Last profession/occupation
9. Are you now
Self-Employed
Unemployed
10. Employer(s) for the last two (2) years of employment
Year
Name of Employer
Address of Employer
Period of Employment
Add Employer
Particulars of Witness to Mark
(Where Claimant cannot sign)
Is the Claimant able to sign?
Yes
No
Witness Name
First Name
Middle Names (if any)
Surname
Address
Street Address
City / District / County
Occupation
Identification
Electoral Identification Card
Passport
Driver's Permit
Submit and Print