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ST. CHRISTOPHER AND NEVIS SOCIAL SECURITY BOARD LIFE CERTIFICATE FOR BENEFICIARY/PENSIONER RESIDENT IN ST. KITTS AND NEVIS Insured Person s Social Security No* Name of Insured Person This certificate shall be completed by a Staff member of the Social Security Board Justice of the Peace Manager of a Bank Medical Practitioner School Principal Community Nurse Minister of Religion or any other responsible person in the community. I the under signed certify that Name of beneficiary/pensioner residing at is alive and was last seen by me on Phone Number Date dd/mm/yyyy Signature of person giving Certificate mark or thumb-print is acceptable if unable to write Certifier s Name print Occupation/Office Title/Stamp Business Address Date signed dd/mm/yyyy Revised Form B24 a 2011. KITTS AND NEVIS Insured Person s Social Security No* Name of Insured Person This certificate shall be completed by a Staff member of the Social Security Board Justice of the Peace Manager of a Bank Medical Practitioner School Principal Community Nurse Minister of Religion or any other responsible person in the community. I the under signed certify that Name of beneficiary/pensioner residing at is alive and was last seen by me on Phone Number Date dd/mm/yyyy Signature of person giving Certificate mark or thumb-print is acceptable if unable to write Certifier s Name print Occupation/Office Title/Stamp Business Address Date signed dd/mm/yyyy Revised Form B24 a 2011.

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