NI8
Funeral Grant Claim Application
View Instructions
Clear Form
1
Section A
Particulars of Applicant
2
Section B
Particulars of Deceased
3
Section C
Particulars of Witness to Mark
1
Section A
Particulars of Applicant
2
Section B
Particulars of Deceased
3
Section C
Particulars of Witness to Mark
Particulars of Applicant
1. Name of Applicant
First Name
Middle Names (if any)
Surname
2. Home Address
Street Address
City / District / County
3. Postal Address
My Postal Address is DIFFERENT from my Home Address
4. Date of Birth
5. Valid Identification Document
Electoral Identification Card
Passport
Driver's Permit
6. Telephone Numbers
Home
Phone
Office/Work
Phone
Cell
Phone
7. Relationship to Deceased Insured Person
8. Documents to attach in respect of Deceased Insured Person
a) Death Certificate
b) Birth Certificate and supporting Affidavit(s)
c) Bills and Receipts of Funeral Expenses
d) National Insurance Registration Card
Save and Continue
Particulars of Deceased Insured Person
1. Name Of Deceased
First Name
Middle Names (if any)
Surname
Last Address
Street Address
City / District / County
3. National Insurance Number
4. Gender
Female
Male
5. Date of Birth
6. Birth Certificate PIN No. (If known)
7. Date of Death
8. Did death occur as a result of accident/industrial disease arising from employment?
Yes
No
9. Last Name of Employer
10. Address Of Last Employer
Street Address
City / District / County
11. Did the Deceased work or live in Canada or worked in any of the CARICOM countries?
Yes
No
12. Please indicate the method of payment of benefit
Collect at Service Centre
Mail to Postal Address
Previous Section
Save and Continue
Particulars of Witness to Mark
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
Previous Section
Submit and Print