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Get BS NIB Form B82 2009

Are you Self-Employed 13. Are you receiving income from any other means If yes explain 14. Are you in receipt of any NIB Benefit or Assistance If yes please list 15. Employment History Previous Employer/Company Name End Date Form B82 2009 Start Date Section C Unemployment Details 16. My last day at work was 22. The last day for which I was paid The information given by me on this form is true and correct to the best of my knowledge and belief. I claim Benefit under the National Insurance Act 1972. 23. Claimant s Signature 24. Date IMPORTANT NOTES A. This form MUST be accompanied by a NIB Unemployment Card Form B81 duly stamped by the Department of Labour s Employment Exchange B. 23. Claimant s Signature 24. Date IMPORTANT NOTES A. This form MUST be accompanied by a NIB Unemployment Card Form B81 duly stamped by the Department of Labour s Employment Exchange B. Persons unemployed i. Before April 20 2009 should present a notification/letter of termination from the employer ii. On or after April 20 2009 should provide Termination of Service/Lay-off Certificate Form B80. C. Any person who for the purpose of obtaining benefit under The National Insurance Act knowingly makes any false statement or false representations or produces any document etc. which he/she knows to be false shall be liable to a fine not exceeding Two Thousand Five Hundred Dollars 2 500 or imprisonment for a period not exceeding twelve 12 months or both. The National Insurance Board For Official Use Only Have you seen the Unemployment Card Yes No Of the Commonwealth of The Bahamas Receiving Officer CLAIM FOR UNEMPLOYMENT BENEFIT Section A Claimant Details Mr. Ms. Last Name First Name 2. N*I. Middle Name s 3. Date of Birth dd/mm/yyyy 4. House Street 5. City/Settlement 7. Telephone 1 9. P. O. Box 6. Island 10. Email Address Section B Eligibility Tick Response 11. Are you currently unemployed 12. Are you Self-Employed 13. Are you receiving income from any other means If yes explain 14. Are you in receipt of any NIB Benefit or Assistance If yes please list 15. Employment History Previous Employer/Company Name End Date Form B82 2009 Start Date Section C Unemployment Details 16. Name of last employer/company 17. Address of last employer/company 18. Name of immediate supervisor 19. Telephone number of last employer/company 20. I commenced work at the above employer/company on 21. My last day at work was 22. The last day for which I was paid The information given by me on this form is true and correct to the best of my knowledge and belief* I claim Benefit under the National Insurance Act 1972. 23. Claimant s Signature 24. Date IMPORTANT NOTES A. This form MUST be accompanied by a NIB Unemployment Card Form B81 duly stamped by the Department of Labour s Employment Exchange B. Persons unemployed i. Before April 20 2009 should present a notification/letter of termination from the employer ii. On or after April 20 2009 should provide Termination of Service/Lay-off Certificate Form B80. C. Any person who for the purpose of obtaining benefit under The National Insurance Act knowingly makes any false statement or false representations or produces any document etc* which he/she knows to be false shall be liable to a fine not exceeding Two Thousand Five Hundred Dollars 2 500 or imprisonment for a period not exceeding twelve 12 months or both.

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