Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694232606823.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 [OVERSEAS] 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 Justice of the Peace ANU & BAR High Commission/Embassy Officer Snr.
Employee, CARICOM Social Security Systems I, the undersigned, hereby certify that: ___________________________________________________________________________ Whose signature is affixed on the over-leaf was alive on the ____________day of ________________________________20______ __________________________________________ ________________________________________________ Print name Signature _______________________________________________ Profession ______________________________ ________________________________________________ OFFICIAL STAMP Date