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Senior Citizen Welfare & R.I National Pension Scheme Application For Retirement Pension

This 3-page document is an application form for retirement pension from the Ministry of Social Security and Senior Citizen Welfare in Mauritius. It collects information such as the applicant's name, address, citizenship status, work history, payment details, and a declaration of truth. The form is used to process and determine eligibility for retirement benefits and will be reviewed by multiple officers at the local office and benefits branch.

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Maurice
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108 views

Senior Citizen Welfare & R.I National Pension Scheme Application For Retirement Pension

This 3-page document is an application form for retirement pension from the Ministry of Social Security and Senior Citizen Welfare in Mauritius. It collects information such as the applicant's name, address, citizenship status, work history, payment details, and a declaration of truth. The form is used to process and determine eligibility for retirement benefits and will be reviewed by multiple officers at the local office and benefits branch.

Uploaded by

Maurice
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 6

Registration MINISTRY OF SOCIAL SECURITY, N.

S Page: 1
& SENIOR CITIZEN WELFARE & R.I
REG-APP3 Date:
National Pension Scheme
Application for Retirement Pension

PART I - APPLICANT

1. N.I.C. No.: Claim Code:


2. S.S. No: 3. C.F. No.: / 1

4. Title: 5. Marital Status Date of application

7. Other Names: Local office:

8. Maiden Name:
9. Also known as: Locality:
10. Address:
Pay Site:

11. Tel. No.: Aw. Unit

12. (a) Date of Birth


(b) Place of Birth
(c) B.C. No.: (d) Reg. Year (e) C.S.O.:

(f) Name of father:


(g) Name of mother:
13. Partner's (a) N.I.C No.:
(b) Surname:
(c) Other Names:

14. (a) Marriage: (b) Date:


(c) M.C. No.: (d) C.S.O:

PART 2 - PREVIOUS CLAIM

15. Have you ever Type of Benefit Date of Office


applied for any application
other benefits
Registration MINISTRY OF SOCIAL SECURITY, N.S Page: 2
& SENIOR CITIZEN WELFARE & R.I
REG-APP3 Date:
National Pension Scheme
Application for Retirement Pension

PART 3 - CITIZENSHIP & PERIODS OF RESIDENCE

16. (a) Is applicant a Mauritian Citizen?


17. If not a Mauritian Citizen by birth, record applicant's date of first arrival in
Mauritius.
18. Is applicant residing in Mauritius?
19. Is applicant following indoor treatment in a hospital?
If 'yes', please record (a) Name of hospital:
(b) Date of admission:
20. Nature of Disability:
Can applicant arrange to be present at a Medical Board?
If 'No', reasons:

21. (a) Periods of absence since the date of first arrival:


From To

(b) Passport No.: Date & Place of issue

Remarks

PART 4 - LATE APPLICATION

22. If application is made later than six months after the date of entitlement, please
give reasons:

PART 5 - CONTRIBUTORY RETIREMENT PENSION

23. Claim for Contributory Retirement Pension?

24. Details of employment if contributions to NPF payable:

Employer's Employer's Period of employment Remarks


Occupation Name Address From To
Registration MINISTRY OF SOCIAL SECURITY, N.S Page: 3
& SENIOR CITIZEN WELFARE & R.I
REG-APP3 Date:
National Pension Scheme
Application for Retirement Pension

PART 6 - PAYMENT INTO BANK

25. Name of Bank/Post Office:


26. Account No.:
27. If joint account, please record particulars of the other holder:
(a) N.I.C No:
(b) Name:
(c) Address:

(d) Relationship to applicant:

PART 7 - DECLARATION

28. I declare that the statements made by me and recorded on this form are true to the
best of my knowledge. I undertake inform this Ministry of any change in the
particulars therein.

Date: ……………………………….. …………………………….


Signature/Thumbprint

(a) Signature of Witness (if applicant cannot sign) ………………………………………

Name of witness

Address of witness

N.I.C No.:
Registration MINISTRY OF SOCIAL SECURITY, N.S Page: 4
& SENIOR CITIZEN WELFARE & R.I
REG-APP3 Date:
National Pension Scheme
Application for Retirement Pension

29. PART 8 - PROXY


Registration MINISTRY OF SOCIAL SECURITY, N.S Page: 5
& SENIOR CITIZEN WELFARE & R.I
REG-APP3 Date:
National Pension Scheme
Application for Retirement Pension

PART 9 - REGISTRATION AND CHECKING AT LOCAL OFFICE

30. Application registered by:

Officer's Name:

Documents annexed:
………………………………………………………………………………………………
Remarks:……………………………………………………………………………………

Date: …………………………………
Signature of SSO

31. Documents checked by:

Officer's Name:

Remarks:……………………………………………………………………………………

Date: ………………………………….
Signature of HSSO

PART 10 - CHECKING AT INDEX SECTION, BENEFIT BRANCH

32. Index checked to-day:

(a) there is no previous/there is a previous file


C.F. No.:……………………… P. Site Code:…………………….

(b) there is no connected/there is a connected file

C.F. No.:…………………….. P. Site Code:

Officer's Name: …………………………………………………………………………….

Date: ………………………………………… …………………………………..


Signature of SSO

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