Form NI 79
Application for Refund
View Instructions
Clear Form
Registration Number
Name of Employer
Address
Street Address
City / District / County
Service Centre at which applying
-- select an option --
Arima
Barataria
Chaguanas
Couva
Point Fortin
Port of Spain
Princes Town
Rio Claro
San Fernando
Sangre Grande
Siparia
St. James
Tobago
Tunapuna
List of Insured Persons needing refund
Name of Insured Person
N.I. Number
Postal Address
Period of Overstamping
Amount of Refund
Reason for Overstamping
Still Employed with you
Add Insured Person
Submit and Print