Get Nigeria Social Insurance Form

The Nigeria Social Insurance Form is essential for reporting accidents, occupational diseases, or deaths in the workplace. This guide provides step-by-step instructions on how to complete the form accurately and efficiently online.

Follow the steps to fill out the Nigeria Social Insurance Form accurately.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out Section 1.0 labeled 'Employer.' You will need to provide the name of the employer and the registration number.
3. Proceed to Section 2.0 titled 'Employee.' Here, enter the employee's surname, first name, and middle name. Additionally, include the staff ID number and the earnings of the employee at the time of the accident. Remember to attach a copy of the employee's pay slip.
4. Now move to Section 3.0 for accident details. Input the date and time of the accident, the town and local government area where it occurred, and the state. Fill in the date the employee reported the accident and the time reported. Also, describe the task the employee was performing during the incident.
5. In Section 3.09, indicate whether the accident occurred in the course of work by selecting 'Yes' or 'No.' Then, specify the nature of the injury sustained and indicate if first aid was provided in Section 3.10 and Section 3.11.
6. Fill out the medical details by providing the surname, first name, and practice number of the medical practitioner who treated the employee. Also, state the number of days worked by the employee and the key dates related to the injury or disease, including when the employee ceased and resumed work.
7. If applicable, indicate if the employee died as a result of the accident and provide the names of any registered dependents.
8. For occupational disease reporting, complete Section 4.0 by detailing the nature of work and the disease, along with relevant dates and exposure information.
9. Finally, fill out the declaration section, ensuring you provide accurate information. Sign and date the form before submission.
10. Once you have completed the form, you can save the changes, download, print, or share the completed document as needed.

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