Senior Citizens Pension Form updated PDF

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S.A. - 1

Husband’s/Wife’s Claim

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SENIOR CITIZENS’

desiring to claim Senior Citizens’

Senior Citizens’

The person’s income must not exceed $

The following documents are required to substantiate a claim for Senior Citizens’

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Full Name of Applicant (Block Letters) …………………………………………………………..…. Female

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3. Telephone Number ………………………

Address (give full details) ……………………………………………………………………………. ………………………………………………………………………………………………………... Father’s Name ……………………………………………………………………………... Mother’s Name ……………………………………………………………………………………….

of Birth …………………………………………………………………………… ………………………………………………………………………… ) ……………………………………………………….. …………………………………………………. d and Tobago? ……………………………. Date of departure …………………….…….

Date of return …………………………

Date of departure ………………….…………

Date of return …………………………

Date of departure ………………………….…

Date of return …………………………

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…. If so, state District…………………...

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…………………… Have you been working in Trinidad and Tobago for the last twenty years? ……………………… By whom were you employed? ……………………………………………………………………… ? …………………… ………. ………………………………………………………………………………………………………... State the kind of work you were doing ………………………………………………………………. ? ……………………………………………………………………….. ? …………

(a) What is the value of property (house, land, etc)? ………………………………………………… ? ……………………………………………....…………………...

? ………………………………………………………………………………... ? …………………………………………….. ? …………………………………………. (a) Are you a Government or other pensioner? ……………………………………………………... (b) If so, how much is your monthly pension? ……………………………………………………… Do you pay rent for the house in which you are living? …………………………………………….. How much rent do you pay and to whom? …………………………………………………………... Do you belong to any Friendly Society (Give Name) ……………………………………………….. erty? …………… If so, what does it consist of? ………………………………………………………………………………………………………... Where is it situated? …………………………………………………………………………………. What is the value of the property? …………………………………………………………………… Does your wife/husband live on it? ………………………………………………………………….. If you are a widow, state date of your husband’s death? ……………………………………………. ’ ’

before? ………………………………… ………… in any other district? ……………………………………...

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Senior Citizens’ Senior Citizens’

Senior Citizens’

Applicant’s signature or (mark) ………………………………………….

Witness to declaration ……………………………………...

Address …………………………………………………….. ……………………………………………………… ………

Telephone Number ………………………………………….

…………………………… ……………………. Date ………………………………………………………….

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