Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694232618205.pdf (Antigua and Barbuda)
ANTIGUA & BARBUDA SOCIAL SECURITY BOARD LONG STREET, P.O .Box 1125 ST. JOHN’S, ANTIGUA TEL: (268) 736-3000/1/2/3 FAX: (268) 481-3090 E–mail: customerserv@socialsecurity.gov.ag LIFE CERTIFICATE [LOCAL] PENSIONER’S FULL NAME: _____________________________________________________________________ Social Security No.

: Pension No.
: Type of Pension: AGE INVALIDITY SURVIVORS Signature of Pensioner: __________________________________ Date: ____________________ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- TO BE CERTIFIED BY ONE OF THE PERSONS ON THE OVER-LEAF TO BE CERTIFIED BY TICKING ONE OF THE SPECIFIED PROFESSIONS BELOW: Notary Public Medical Practitioner Bank Official Minister of Religion Social Security Staff Lawyer Registered Nurse School Principal Member of Parliament Retired Senior Soc.
Sec Staff Snr.
Civil Servant I, the undersigned, hereby certify that: ___________________________________________________________________________ Whose signature is affixed on the over-leaf was alive on the _____________day of _______________________________20______ __________________________________________ ________________________________________________ Name of Church Sig nature (Applicable to Minister of Religion) _______________________________________________ Print name ______________________________ Affix Stamp Date: _________________________ _______________________________________________ Profession