Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694878331983.pdf (Antigua and Barbuda)
MEDICAL BENEFITS SCHEME NOTICE OF DISCONTINUATION OF BUSINESS Important Read Carefully You need to notify the Medical Benefits Scheme when you close your business.

This allows the Scheme to close your account.

Failure to properly notify the Scheme may cause unwanted correspondence and/or additional contacts for estimated arrears as your business may be viewed as owing outstanding contributions.
You need to be specific and accurate in providing the relevant information, as it is a criminal offence, subject to penalties under the MBS Act, for failure to pay your contributions.

1.

Registration Number: _______________________ 2. Business Name: _____________________________ 3. Business Address: __________________________ 4. Business Telephone Number: __________________ 5.

Owner’s/Officer’s Name: ____________________ 6.

Current Address: ____________________________ 7.


Telephone Number: _________________________ 8.

Cell Number: _______________________________ 9.

On ____________________________, 20__________, this business will discontinue operations: Permanently 10.

The undersign requests: Temporarily: Period Start Date: ____________ Period End Date: __________ dd/mm/yyyy dd/mm/yyyy The registration is cancelled and the account closed.

The account is temporarily closed.


If closure (permanent end of business) complete # 11 & 12 or skip to # 13: 11.

Does the business currently have employees?

Yes No If yes, the effective date the employees will be severed: _________________ dd/mm/yyyy 12.

Has there been a transfer or a change of ownership?
Yes No If yes, state below: Trade name of new business: ___________________________________________________________ New owner’s name: __________________________________________________________________ Starting date of new business: ______________________ dd/mm/yyyy 13.

If this is a consolidated registration, are all locations being closed?
specific locations to be closed: __________________________________________________________________________________________ If no, list No Yes __________________________________________________________________________________________ Signature of Employer: ________________________ Title: __________________ Date: __________ Prepared by: _________________________________ Date: __________________________________ Nevis Street, P.O.
Box 424, St. John’s, Antigua Telephone: (268)481-6200/6211/12 Fax: (268) 481-6370 /6330 For Official Use Was the date that the business was discontinued estimated?

Accounts receivable and records remain to be collected?

A warrant is recommended?
Yes Yes Yes No No No Comments: ________________________________________________________________________________ _________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Prepared By (Invigilator): ______________________________________________ Date: __________ Account Status Changed By (Registration Clerk): _______________________ Date: __________