Transcription of The National Insurance Act, 1972 Commonwealth …
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The National Insurance Act, 1972 Commonwealth …
The National Insurance Act, 1972 Commonwealth of The BahamasIMPORTANT NOTESA claim for Injury, Maternity or Sickness Benefit means that an employeeis/was temporarily unable to work because of an injury, childbirth orillness. This form elicits the employer s confirmation that the claimantwas/is, indeed, absent from work on the dates S CERTIFICATE - MED 4 Form Med 4 (2015)For Official Use OnlySurnameFirst NameMiddle Name(s)dd/mm/yyyydd/mm/yyyydd/mm/yyyyPTO >>dd/mm/yyyydd/mm/yyyyTO BE COMPLETED BY CLAIMANT S EMPLOYER1. I certify that: Mr. Mrs. Ms. _____N. I. Number:Employee No. _____Is/has been employed with: _____Employer _____ to_____2. He/She is/was off from work due to: Sickness / Maternity / Injury / Vacation / Other leaveas follows:Employee s last day at work:_____If already returned to work, first day back:_____If not yet returned to work, expected date of return: _____Employee s fixed day(s) off:Sun Mon Tues Wed Thur Fri Sat I, hereby, acknowledge that I understand I have an obligation to advise the National Insurance Board ifthis Claimant returns to work sooner than the date indicated I certify that the information contained on this form is true to the
The National Insurance Act, 1972 Commonwealth of The Bahamas IMPORTANT NOTES A claim for Injury, Maternity or Sickness Benefit means that an employee is/was temporarily unable to work because of an injury, childbirth or
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