Claims Checklist
FUNERAL GRANT
- COMPLETED CLAIM FORM - NI 8
- DEATH CERTIFICATE OF INSURED
- RECEIPT – bearing the name of the person (the applicant) who has stood the expenses for the turnout and referencing the name of the deceased
- NATIONAL INSURANCE REGISTRATION CARD OF THE DECEASED (if available)
SICKNESS BENEFIT
- COMPLETED CLAIM FORM – NI 15 (First claim)
- NI 15A (CONTINUATION CLAIM)
- BIRTH CERTIFICATE (IF APPLICANT IS AGE 60+)
- AFFIDAVIT/DEED POLL/MARRIAGE CERTIFICATE IF NECESSARY (Name not on Birth Certificate, Name different to what is on birth certificate)
MATERNITY BENEFIT
- COMPLETED CLAIM FORM – NI 12
SPECIAL MATERNITY BENEFIT
- COMPLETED CLAIM FORM - NI 13
- AFFIDAVIT FROM BOTH PARENTS (IF COMMON LAW RELATIONSHIP)
- MARRIAGE CERTIFICATE
INJURY BENEFIT
- COMPLETED CLAIM FORM - NI 19
- NI 19A (Continuation medical where applicable)
MEDICAL EXPENSES
- COMPLETED CLAIM FORM – NI 114
- RECEIPTS OF EACH EXPENSE BEING CLAIMED
- REFERRAL LETTER FROM DOCTOR (If referred to another provider e.g. Chiropractor, Physiotherapist etc.)
DISABLEMENT BENEFIT
- COMPLETED CLAIM FORM – NI 119
- STATEMENT FROM EMPLOYER IN RESPECT OF ACCIDENT IF INJURY BENEFIT WAS NOT CLAIMED
RETIREMENT BENEFIT
- COMPLETED CLAIM FORM – NI 82
- BIRTH CERTIFICATE (Electronic)
- AFFIDAVIT (Where necessary)
- MARRIAGE CERTIFICATE (Female applicant)
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- DEED POLL (If applicable)
- ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)
INVALIDITY BENEFIT
- COMPLETED CLAIM FORM –NI 38
- BIRTH CERTIFICATE (Electronic)
- AFFIDAVIT (Where necessary)
- DEED POLL (If applicable)
- MARRIAGE CERTIFICATE (Female applicant)
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)
SURVIVOR
COMPLETED CLAIM FORM – NI51 (Claim form is the same for each category)
BIRTH CERTIFICATE OF APPLICANT (Electronic
AFFIDAVIT (Where necessary)
- DEED POLL (If applicable)
- MARRIAGE CERTIFICATE (Female applicant)
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- ALTERNATIVE EVIDENCE OF CONTRIBUTIONS (IF NECESSARY)
SURVIVOR (COMMON LAW)
- COMPLETED CLAIM FORM – NI51
- BIRTH CERTIFICATE OF APPLICANT (Electronic
- AFFIDAVIT (Where necessary)
- DEED POLL (If applicable)
- SELF SWORN DECLARATION FROM APPLICANT
- DECLARATIONS FROM THREE PROMINENT PERSONS TO ESTABLISH KNOWLEDGE OF THE PARTIES COHABITING
If previously married, then -
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)
If deceased was previously married, then –
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)
CHILD ALLOWANCE
- COMPLETED CLAIM FORM – NI 51
- CHILD’S BIRTH CERTIFICATE
- AFFIDAVIT WHERE NECESSARY
- PROOF OF PATERNITY WHERE NECESSARY
- MEDICAL CERTIFICATE IF DISABLED
ORPHAN’S ALLOWANCE
- COMPLETED CLAIM FORM - NI 51
- Death Certificate of both parents (if both were insured persons)
- BIRTH CERTIFICATE OF ORPHAN
- AFFIDAVIT WHERE NECESSARY
- PROOF OF PATERNITY WHERE NECESSARY
- MEDICAL CERTIFICATE IF DISABLED
DEPENDANT PARENT
- COMPLETED CLAIM FORM - NI 51
- Birth certificate of the deceased (Affidavit if father’s name is not on deceased’s birth certificate)
- AFFIDAVIT OUTLINING EXPENSES AND CONTRIBUTION OF THE DECEASED
- PROOF OF DECEASED’S CONTRIBUTION TO PARENTS’ UPKEEP (BILLS AND RECEIPTS)
DEATH BENEFIT
- COMPLETED CLAIM FORM– NI117 (Claim form is the same for each category)
- BIRTH CERTIFICATE OF APPLICANT (Electronic
- AFFIDAVIT (Where necessary)
- DEED POLL (If applicable)
- MARRIAGE CERTIFICATE (Female applicant)
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
DEATH BENEFIT (COMMON LAW)
- COMPLETED CLAIM FORM – NI117
- BIRTH CERTIFICATE OF APPLICANT (Electronic)
- AFFIDAVIT (Where necessary)
- NOMINATION OF SPOUSE (NI 42 Where applicable)
- DEED POLL (If applicable)
- SELF SWORN DECLARATION FROM APPLICANT
- DECLARATIONS FROM THREE PROMINENT PERSONS TO ESTABLISH KNOWLEDGE OF THE PARTIES COHABITING
If previously married, then -
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)
If deceased was previously married, then –
- DECREE ABSOLUTE OF DIVORCE (Where applicable)
- Or DEATH CERTIFICATE OF PREVIOUS SPOUSE(S)
CHILD ALLOWANCE
- COMPLETED CLAIM FORM – NI 117
- CHILD’S BIRTH CERTIFICATE
- AFFIDAVIT WHERE NECESSARY
- PROOF OF PATERNITY WHERE NECESSARY
- MEDICAL CERTIFICATE IF DISABLED
DEPENDANT PARENT
- COMPLETED CLAIM FORM – NI 117
- BIRTH CERTIFICATE OF THE DECEASED (AFFIDAVIT IF FATHER’S NAME IS NOT ON DECEASED’S BIRTH CERTIFICATE)
- AFFIDAVIT OUTLINING EXPENSES AND CONTRIBUTION OF THE DECEASED
- PROOF OF DECEASED’S CONTRIBUTION TO PARENTS’ UPKEEP (BILLS AND RECEIPTS)
ALL CLAIMS
- IF POSTAL – PROOF OF ADDRESS (Utility bill)
- IF FINANCIAL INSTITUTIONS - PROOF OF FINANCIAL INFORMATION
- IDENTIFICATION DOCUMENT OF APPLICANT (Valid document - EID CARD, PASSPORT, DRIVER’S PERMIT
- IDENTIFICATION DOCUMENT OF THIRD PARTY – WHERE APPLICABLE (Valid document - EID CARD, PASSPORT, DRIVER’S PERMIT)
