Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694265966788.pdf (Mauritius)
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.

2.

4.

7.

N.I.C.

No.

: S.S. No: Title: Other Names: 8.

9.

10.

Maiden Name: Also known as: Address: Claim Code: 3.

C.F.

No.

: / 1 5.

Marital Status Date of application Local office: Locality: 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.


: 13.

(f) Name of father: (g) Name of mother: Partner's (a) (b) (c) N.I.C No.

: Surname: Other Names: 14.

(a) Marriage: (c) M.C.

No.

: (b) Date: (d) C.S.O: PART 2 - PREVIOUS CLAIM 15.


Have you ever applied for any other benefits Type of Benefit Date of application Office 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.

17.

18.

19.

20.

(a) Is applicant a Mauritian Citizen?

If not a Mauritian Citizen by birth, record applicant's date of first arrival in Mauritius.
Is applicant residing in Mauritius?

Is applicant following indoor treatment in a hospital?

If 'yes', please record (a) Name of hospital: (b) Date of admission: 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: Occupation Employer's Employer's Name Address Period of employment Remarks 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.

26.

27.

Name of Bank/Post Office: Account No.


: If joint account, please record particulars of the other holder: (a) (b) (c) N.I.C No: Name: 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: 31.

Documents checked by: Officer's Name: ………………………………… Signature of SSO 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