APPLICATION FOR EMPLOYER, SECONDARY, SELF-EMPLOYED &
VOLUNTARILY INSURED PERSONS
NOTE: Branches with individual payrolls are required to register as a separate employer.
PLEASE PRINT OR TYPE

Nationality *  :
Application Type* :

Domestic Employer *  :
(Caregiver, Caretaker, Housekeeper)

 Required Documents
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Employer/Owner must provide a National Insurance Card and Passport or Voter’s Card.
Non-Bahamian Employer/Owner/Self Employed/Secondary must provide a Letter of Authorization from the Bahamas Investment Authority along with a current Work Permit, Passport and National Insurance Card.
Agent to provide a letter of Authorization from the Employer/Owner along with employer/owner Government issued I.D. and the employer/owner’s Passport and agent’s photo I.D. (Government issued I.D.)
‘Limited’ companies (item 7), must provide a copy of the Certificate of Incorporation.
Name change:
Limited company/Corporation needs a name change certificate
    Private company needs a letter from employer/owner.

 Business Details
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1. Business name * :
2. Trading name of business:
3. Employer TIN:
4. Business Start Date * : 5. Type of business* :
6. Business license number: 7. Is business a ‘Limited’ company?:
8. Certificate of incorporation number:
9. Is business a Partnership?:
10. Name of partner:
11. Director’s name: 11b. Position:
11c. Director’s name: 11d. Position:
12a. Contact person* : 12b. Position:
13. Do you have a computerized payroll system?:



Address Information
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19a. P.O.Box :
19b. Street/Location* :
Country* :
City/Settlement * :
Island* :
19c. Direction to Business *  :
20. Contact Preference * :
21. Phone:
Primary Number* :
Secondary Number:
Other:
22. E-Mail:
Primary* :
Confirm Primary* :
Secondary:
Confirm Secondary:
23. Fax:
24. Web Address:

Declaration
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I    hereby confirm to the best of my knowledge and belief, that the information contained herein is true and correct. I also understand that failure to provide the correct information may result in the cancellation of any or all approvals previously granted.

  Instructions for Completing Form
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  • Form R.1 is to be either typed or filled in ink.
  • The registration number for the company must be entered. Where the registration number is unknown or application is being made for a new registration number, the section item is to be left blank and will be filled in by the Local Office.
  • When registering as a business, the full company’s name is required in item 1. Item 2 is to be used for the company’s trading name. Item 14 and 15 only relate to Self Employed/Voluntarily insured persons. Items 16 - 18 are to be used only by Secondary Registrants.
  • ‘CONTACT PERSON’ in (item 12a), should be the individual who is directly responsible for submitting National Insurance contributions.
  • Item 25, requires the signature of either the owner or the manager along with the company’s stamp. For Self Employed/Voluntarily insured persons, the signature and stamp are also required.
  • Entities with computerized payroll systems are required to electronically submit their monthly contribution statements.
  • If you employ any staff you are required under The National Insurance Board Act to register your business with the National Insurance Board within ten(10) days of employment. (Failure to register will result in legal prosecution).

 NOTE
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Any person who for the purpose of obtaining an Employer, Self-Employed, Secondary or Voluntarily Insured registration number under the National Insurance Act, for himself or a business, knowingly makes any false statement or false representations or produces any document, etc. which he knows to be false, shall be liable to a fine not exceeding Two Thousand Five Hundred Dollars ($2,500), or to imprisonment for a period not exceeding twelve (12) months or both. You are required to provide NIB with update information if any of the above changes.