CHAPTER 50
NATIONAL SOCIAL SECURITY FUND ACT
[SUBSIDIARY LEGISLATION]
INDEX TO SUBSIDIARY LEGISLATION
REGULATIONS
TABLE OF CONTENTS
Regulations
Title
PART I
PRELIMINARY PROVISIONS
1. Citation.
2. Interpretation.
PART II
REGISTRATION
3. Registration by contributing employer.
4. Registration number.
5. Return as to employees.
6. Membership cards to insured persons.
7. Duplicate membership cards.
8. Change of status.
9. Members of the National Provident Fund.
10. Conversion of paid contributions.
11. Religious organisations.
12. Insured person contributing on his own behalf.
13. Forms.
PART III
PAYMENT OF CONTRIBUTIONS
14. Payment by contributing employer.
15. Recovery of employee’s contribution.
16. Mode of payment.
17. Record of employment.
18. Record of wages, etc.
19. Contributions report.
20. Successive or concurrent employment.
21. Disposition of employer’s records.
22. Payment of contributions for employees working abroad.
23. Payment of contributions for non-citizens.
PART IV
BENEFITS
24. Application for benefits.
25. Transition period.
26. Limitation of claims.
27. Notification.
28. Entitlement.
29. Further evidence.
30. Statutory declaration.
31. Medical examination.
32. Payment of benefits.
33. Receipt of benefits.
34. Delivery by post.
35. Payments to disabled persons.
PART V
EVIDENCE IN CLAIMS
36. Evidence supporting application for benefits.
PART VI
CONTINUING ELIGIBILITY, SUSPENSIONS AND TERMINATIONS
37. Verification of continuing eligibility of a beneficiary.
38. Information required from insured persons.
39. Suspension of benefits in general.
40. Suspension for failure to comply with request for information.
41. Suspension of benefits for persons in prison.
42. Suspension resulting from uncertain address or residence.
43. Period of suspension.
44. Administrative review of suspension, etc.
45. Termination of a benefit.
46. Grounds for termination.
PART VII
REFUND AND RECOVERY OF OVER PAYMENTS
47. Refund of excess contributions.
48. Receipt of refund.
49. Recovery from a living beneficiary who is at fault.
50. Recovery from a beneficiary who dies before adjustment.
51. Recovery from a living beneficiary who is not at fault.
52. Waiver of recovery.
PART VIII
PROCEDURAL REQUIREMENTS, ADMINISTRATIVE REVIEW AND DETERMINATION
53. Notification of requirements to beneficiary.
54. Beneficiary obligations.
55. Rights of insured person.
56. Request for review.
57. Decision in writing.
58. Advance notice.
PART IX
RECORDS
59. Records of earnings.
60. Access to records.
61. Statement of earnings and estimate of benefits.
62. Request of record.
63. Correction of records.
64. Records maintained by the employer.
65. On site review of records maintained by employer.
66. Obstruction.
PART X
GENERAL PROVISIONS
67. Minimum pension.
68. Lump sum payment.
69. Reduced pension.
70. Late entrants.
71. Signing of forms and documents.
72. Incomplete or inaccurate documents.
73. Duty of employees.
74. Discretion as to classification.
75. [Revocation.]
SCHEDULE
THE NATIONAL SOCIAL SECURITY FUND (GENERAL) REGULATIONS
(Sections 50 and 89)
G.N. No. 418 of 1998
PART I
PRELIMINARY PROVISIONS (regs 1-2)
1. Citation
These Regulations may be cited as the National Social Security Fund (General) Regulations.
2. Interpretation
In these Regulations unless the context otherwise requires–
"the Act" means the National Social Security Fund Act;*
"attesting witness" includes a member of Parliament, a judge or a magistrate, an advocate, an Area Commissioner, a Regional Commissioner, a public servant of or above the executive grade, a consular officer, a kadhi, a member of the local government service of or above the executive grade, a minister of religion, a bank official of or above supervisory grade, a qualified medical practitioner;
"beneficiary" means a person receiving a benefit under the Act;
"claimant" means a person who has applied to the Fund for a benefit under the Act;
"Fund" means the National Social Security Fund established under section 3 of the National Social Security Fund Act *;
"Minister" means the Minister responsible for labour matters.
PART II
REGISTRATION (regs 3-13)
3. Registration by contributing employer
A contributing employer who is required to register under the Act who was not registered under the National Provident Fund shall, within one month from the commencement of the Act or the date when the person concerned becomes a contributing employer, complete and deliver to the Fund the registration Form NSSF 1 prescribed in the Schedule.
4. Registration number
The Director-General shall allot a registration number to every registered contributing employer.
5. Return as to employees
Every register contributing employer shall forthwith complete and forward to the Director-General the appropriate form in respect of all his employees registrable as insured persons to the Fund.
6. Membership cards to insured persons
The Director-General shall forward to every contributing employer a membership card for each insured person to the Fund in his employ and every contributing employer to whom such membership card is sent shall forthwith hand it or cause it to be handed to the employee concerned, or if the employee is no longer in his employment he shall return it to the Director-General.
7. Duplicate membership cards
(1) If the membership card of an insured person under the Act is lost or destroyed the insured person may apply to the Director-General for the issue to him of a duplicate membership card in place thereof.
(2) The Director-General may, if he sees fit, issue the duplicate card after obtaining from the insured person or his contributing employer such information as may be required for the completion of the duplicate and may make a charge of five thousand shillings for it.
(3) Every duplicate membership card shall, before issue have written upon it “Duplicate” and the date of issuance.
8. Change of status
(1) Every registered contributing employer shall within fourteen days notify the Director-General in the appropriate form set in the schedule to these Regulations of any change of address, business name or designation.
(2) Every contributing employer shall notify the Director-General of the date when insured person to the Fund ceases to be in his employ and shall furnish the Director-General such further information as the Director-General may require for the purpose of tracing that insured person.
9. Members of the National Provident Fund
Every person who was registered as a member of the National Provident Fund shall be considered as having registered under the Fund as of the date the Act came into operation.
10. Conversion of paid contributions
The contributions paid and credited every year to an insured person under the National Provident Fund shall be converted into contribution credits under the Act by multiplying the contribution balance as at the 30
11. Religious organisations
A religious organisation desiring to make contribution in respect of any minister of religion in accordance with section 7 of the Act, shall make application on the appropriate form set out in the Schedule to these Regulations.
12. Insured person contributing on his own behalf
An insured person wishing to make payments on his own behalf in accordance with section 17 shall send an application to the Director-General.
13. Forms
The forms in the schedule to these Regulations are applicable, and where they are not applicable, forms of a like character with such variations as circumstances may require shall be used for the purposes of the Act and these Regulations
PART III
PAYMENT OF CONTRIBUTIONS (regs 14-23)
14. Payments by contributing employer
(1) Every contributing employer shall, on behalf of any covered employee, pay to the Fund a contribution that consists of the employer’s and employee’s contribution at the percentage stipulated in the First Schedule to the Act:
Provided that where an insured female employee is on receipt of maternity benefit, the employer shall be liable to pay to the Fund the employers contribution only.
(2) Every person contributing under the Act shall pay the amount due within one month after the end of the month in which the last day of the contribution period to which it relates, falls.
15. Recovery of employee's contribution
(1) The contributing employer shall recover from every employee the amount paid as the employee’s contribution from the earnings of the employee for the contribution period to which the contribution relates.
(2) The contributing employer shall not be entitled under any circumstance–
(a) to recover from the employee;
(b) to negotiate with the employee;
(c) the recovery from him of any portion of the employer’s share or any part of any penalty associated with late payment of a contribution.
16. Mode of payment
All contributions to the Fund shall be paid to the Fund either–
(a) in cash at the Head office of the Fund or other office designated for the purpose by the Director-General;
(b) by money order, postal order or cheque or debit-note drawn on any bank in Mainland Tanzania, delivered or sent by post to such office or offices of the Fund as may be designated for the purpose;
(c) by standing order at any bank in Mainland Tanzania;
(d) in such other manner as the Director-General may from time to time authorise in any particular case or class of cases.
17. Record of employment
Every contributing employer shall keep and maintain a record of employment in the form set out in the Schedule, in which he shall make necessary entries from time to time, in respect of every person employed by him.
18. Record of wages, etc.
Every contributing employer shall enter on a record of all wages paid and all statutory contributions payable during the month on a form set out in the Schedule and shall forward that record simultaneously with the appropriate contributions to the Director-General.
19. Contributions report
(1) Every contributing employer shall send to the Fund a contributions report providing the following particulars–
(a) the employer’s name, physical and postal address, and NSSF registration number;
(b) the method of payment of the contribution;
(c) for each employee on whose behalf a contributions was made–
(i) name and membership card number;
(ii) total and pensionable earnings for the contribution period reported;
(iii) the amount of the employer’s contribution; and
(iv) the amount of the employee’s contribution.
(2) The contributing employer shall submit an original of the earnings and contributions report to the Fund and shall retain at least a copy for the employees.
20. Successive or concurrent employment
Where an insured person is–
(a) successively employed by two or more contributing employers in the same contribution period; or
(b) concurrently employed by two or more contributing employers in the same contribution period,
the Director-General may, on application by the contributing employers and the insured person–
(i) refund such part of the contribution paid to the Fund as may exceed the contribution that would have been paid for that period if the insured person had been employed by only one contributing employer in that contribution period; or
(ii) direct that the contributions payable in respect of the insured person be reduced so that in the aggregate they do not exceed the amount that would have been payable had the insured person been employed by only one contributing employer.
21. Disposition of employer's records
When an employer disposes of the assets of his business or closes the business, he shall deposit with the Fund his record of payment of contributions to the Fund.
22. Payment of contributions for employees working abroad
(1) A contributing employer who assigns an employee to undertake duties under his contract of service for the employer outside Mainland Tanzania shall notify the Fund and shall together with the employee be liable to contribute to the Fund as if the employee were in Mainland Tanzania.
(2) The provisions of subregulation (1) shall be subject to any agreement to which the Government may reach with Governments of other countries concerning cooperative arrangements to provide for collection of contributions and payment of benefits for employees working abroad.
23. Payment of contributions for non-citizens
A contributing employer who employs a non-citizen shall pay contributions on his behalf subject to any agreement of other countries concerning cooperative arrangements to provide for collection of contributions and payment of benefits for employees working abroad.
PART IV
BENEFITS (regs 24-35)
24. Application for benefits
An insured person shall apply for benefits by completing and delivering the appropriate form accompanied by appropriate supporting documents to the office of the Fund.
25. Transition period
Any insured person who applies and qualify for retirement, invalidity or survivors pension within the first five years of the Fund, may opt for lump sum payment under the National Provident Fund or monthly pension under the Act.
26. Limitation of claims
Limitation for making the following benefit claims shall be as follows, namely–
(a) application for maternity benefit or work injury benefit shall not be accepted after twelve weeks following the date of the delivery or injury;
(b) application for funeral grant shall not be accepted after eight weeks following the date of burial and the payment of this benefit shall be done only where the deceased insured person was in employment at his time of death:
Provided that for any good reason the Director-General may consider any claim even after expiry of the limitation period.
27. Notification
An insured person who is about to retire shall notify the Director-General of his retirement six weeks before the date of retirement.
28. Entitlement
No insured person shall be entitled at any time to more than one benefit.
29. Further evidence
The Director-General may require from the claimant–
(a) such further evidence of entitlement to a benefit as is in his opinion necessary to substantiate the claim for the benefit;
(b) the authentication by an attesting witness of the signature of the insured person to the application for a benefit.
30. Statutory declaration
The Director-General may require any person who has made an application for a benefit to make a statutory declaration as to the truth of any statement of fact made by him in his application or in any evidence.
31. Medical examination
The Director-General may refer any claimant entitled to a benefit, for examination by a Medical Board and may use the report as evidence in deciding the members claim to benefit.
32. Payment of benefits
The Director-General shall pay the amount of any benefit by the cheque or any other suitable instrument of payment.
33. Receipt of benefits
The receipt of a member of the Fund or his attorney or the person authorised to receive the amount on his behalf, shall be a full and sufficient discharge to the Fund for the sum specified therein.
34. Delivery by post
The position of a letter containing an instrument of payment sent pursuant to these Regulations, addressed to the person concerned at the address furnished on the application form, shall as regards to the liability of the Fund, be equivalent to the delivery of the instrument of payment to the person to whom the latter was addressed:
Provided that where it is satisfied that the instrument of payment has been lost or destroyed, the Director-General may issue a duplicate or other instrument of payment, on production of duly executed indemnity to the Fund.
35. Payments to disabled persons
(1) Where the Director-General is satisfied that an insured person is of unsound mind or is unfit to manage his own affairs and no person has been appointed in respect of that person, he may approve payment of the amount or part of it to any other person who satisfies that he is the proper person to receive the amount in that person’s behalf and will apply the amount for the maintenance and benefit of the insured person under disability.
(2) The claimant under subregulation (1) shall produce a nomination certificate from court showing that he is the person to receive the benefit and a medical certificate showing that the insured person is of unsound mind.
PART V
EVIDENCE IN CLAIMS (reg 36)
36. Evidence supporting application for benefits
(1) Every insured person who makes a claim for a benefit shall furnish such certificates, documents, information, and evidence as the Fund may reasonably require in order to establish his identity and his right to the benefit.
(2) In the case of a claim for retirement benefit the claimant shall furnish the following, namely–
(a) application form and other operational forms;
(b) membership card;
(c) a birth certificate or any other form from a medical board to certify the pensioner’s age;
(d) contribution record showing 180 monthly contributions; and
(e) a certificate to show permanent retirement from employment.
(3) In the case of an early retirement pension, the claimant shall furnish the following, namely–
(a) membership card;
(b) a birth certificate or any other document to certify the age of the pensioner;
(c) contribution record to show the 180 monthly contributions; and
(d) a certificate to show the termination from employment.
(4) In the case of an invalidity pension, the claimant shall furnish the following, namely–
(a) application form and other operational forms;
(b) membership card;
(c) a medical certificate and invalidity assessment from the medical board to certify the invalidity;
(d) contribution record show the required contributions have been paid; and
(e) a certificate of retirement from employment due to morbid condition.
(5) In the case of a survivors pension, the claimant shall furnish the following, namely–
(a) death certificate or burial permit;
(b) other forms to support the eligibility of the claimant to the benefit.
(6) In the case of maternity benefit, the claimant shall furnish the following, namely–
(a) a medical certificate to certify the expected date of delivery;
(b) membership card;
(c) contribution record to show payment of requirement contribution; and
(d) additional forms to support other claims (if any).
(7) In the case of funeral grant, the claimant shall furnish the death certificate, a burial certificate, a proof that the deceased was still employed at the time of his death, receipts for the expenses incurred and proof of relation to the deceased.
(8) In the case of employment injury benefit, the claimant shall furnish the following, namely–
(a) membership card; and
(b) certificate of the medical board for temporary or permanent disability of an insured person.
(9) In the case of a claim to health insurance benefit payable to the insured person his or her the spouse and four children, the claimant shall furnish evidence of his contribution for a minimum of three months immediately preceding the medical contingency.
PART VI
CONTINUING ELEGIBILITY, SUSPENSIONS AND TERMINATIONS (regs 37-46)
37. Verification of continuing eligibility of a beneficiary
In determining whether a pension continues to be payable to a beneficiary the Fund shall use the following factors, namely–
(a) the beneficiary’s age;
(b) whether the beneficiary is alive; or
(c) whether the beneficiary is remarried; or
(d) whether the beneficiary is engaged in full-time education; or
(e) whether the beneficiary is working; or
(f) whether the beneficiary has recovered from the impairment.
38. Information required from insured persons
(1) Where a beneficiary is receiving a retirement pension, the Fund shall require the beneficiary to declare annually whether he has been working and the extent of his earnings since the previous determination.
(2) Where a beneficiary is receiving an invalidity pension, the Fund shall require the beneficiary, or his guardian or his representative payee, as the case may be to–
(a) declare whether he has been working and the extent of his earnings since the previous determination; and
(b) report whether his capacity to engage in substantial gainful employment has increased.
(3) Where the benefit is a survivors pension, the Fund shall require–
(a) a spouse to report whether he has remarried; or
(b) a child of the deceased insured person receiving a pension on the ground that he is engaged in full-time education, to report whether he has completed or withdrawn from full-time education.
39. Suspension of benefits in general
The Fund shall suspend an insured person’s benefits if he still alive but does not meet the conditions of eligibility provided in these Regulations.
40. Suspension for failure to comply with request for information
(1) The Fund shall suspend payment of any periodic benefit for failure of the beneficiary to provide information necessary to determine continuing eligibility.
(2) The Fund shall notify the beneficiary of the intention to suspend payment within fourteen days after the second monthly written inquiry sent to the beneficiary with no response to it.
(3) The inquiry shall state–
(a) what information is needed;
(b) why the information in paragraph (a) is needed;
(c) what the beneficiary must do to comply with the request to avoid suspension of the benefit;
(d) how the beneficiary should communicate the required information; and
(e) when the beneficiary shall provide that information.
(4) If within one year the beneficiary provides information confirming his eligibility, the Fund shall resume payments, reinstate payments for up to six previous months for which the insured person continued to meet eligibility requirements.
41. Suspension of benefits for persons in prison
(1) The Fund shall suspend payment of any benefit to a person for any period during which he is confined for a period of one year or more in a penal institution.
(2) The Director-General may authorise payment to, or on behalf of the dependants of the prisoner of an amount not exceeding three quarters of the benefit which would otherwise be payable, if he is satisfied that the dependants, immediately prior to prisoner’s detention, were wholly or mainly maintained by the detained.
42. Suspension resulting from uncertain address or residence
(1) The Fund shall suspend payment of a benefit if–
(a) the bank or record where the Fund makes payment to the beneficiary notifies the Fund that the beneficiary account has been closed or that the beneficiary is unknown;
(b) the post office returns mail addressed to the beneficiary at the address of record as undeliverable.
(2) When the beneficiary provides a suitable address, the Fund shall resume payments, reinstating suspended payments for up to six previous months provided the insured person continued to meet eligibility requirements during that time.
43. Period of suspension
During the period of suspension–
(a) payments to the beneficiary are halted until the insured person provides evidence that he again meets the requirements that gave rise to his lapse of eligibility; and
(b) the insured person shall not be required to reapply and shall be required to furnish documentation of age, residence, insured status, invalidity, employment and family or marital status only if such documentation relates directly to the grounds for suspension.
44. Administrative review of suspension, etc.
An insured person is entitled to request for an administrative review of a suspension, reduction or termination of a benefit.
45. Termination of a benefit
Where the Fund terminates a benefit, the insured person is declared ineligible.
46. Grounds for termination
Eligibility for a benefit is terminated upon the following grounds, namely–
(a) where the beneficiary has not re-established eligibility twelve months after suspension of a benefit; or
(b) death of the beneficiary.
PART VII
REFUND AND RECOVERY OF OVERPAYMENTS (regs 47-52)
47. Refund of excess contributions
(1) Subject to the provisions of this regulation, where the Director-General is satisfied that any amount has been paid to the Fund in excess of the amount that was due to be paid, he may subject to the provisions of subregulation (3) refund the amount so paid in excess to the person by whom it was made:
Provided that–
(a) if the excess payment was in the opinion of the Director-General made by error due to gross negligence on the part of the person by whom it was made;
(b) if the refund of such excess payment is not claimed within three years of the date on which it was made;
(c) if the insured person in respect of whom it was made has withdrawn it as a benefit,
such excess payment shall not be refunded but shall be deemed to have been properly made and shall unless credited to the records of the insured person or insured persons in respect of whom it was made.
(2) Where any amount is due to the Fund from the person to whom refund of the amount paid in excess would otherwise be made, the Director-General may retain the whole or any part of the excess payment and set it off against such amount as is due.
(3) No refund shall be made and no amount shall be offset under this regulation except with the consent of the Director-General who may require the person by whom the excess payment was made to make a written application for refund and to furnish such information as he may require to determine the amount of the excess payment and the circumstances in which it occurred.
(4) If any contribution or part of a contribution paid in excess is refunded to any person after it has been in the Fund throughout the whole of a financial year, the Director-General may, at his discretion increase the amount repaid by adding thereto interest at fifty per centum of the rate of commercial interest for that year.
48. Receipt of refund
Where an excess payment has occurred any portion of which has been withheld or deducted from an employee’s earnings, the Director-General shall refund to the employee the amount withheld or deducted in excess of the correct amount.
49. Recovery from a living beneficiary who is at fault
If the beneficiary who has been overpaid is entitled to a monthly pension or lump sum at the time of determination of the overpayment, the Fund shall not pay any monthly benefit or any lump sum until the amount of the overpayment has been withheld or refunded.
50. Recovery from a beneficiary who dies before adjustment
Where an insured person who has received overpayment is at fault for it and dies before full recovery of the overpayment, the Fund shall not pay any monthly benefit or lump sum to any survivors on his earnings record until the amount of the over payment has been withheld or refunded.
51. Recovery from a living beneficiary who is not at fault
Where the beneficiary is not at fault and where the Fund determines that withholding the full amount of the monthly entitlement would deprive the beneficiary of income required for ordinary and necessary living expenses, the Fund may effect the adjustment by withholding not less than five percent of the monthly benefit payable to the individual until the amount of the overpayment is withheld.
52. Waiver of recovery
The Board may waive recovery of an overpayment where–
(a) the insured person on whose earnings record the overpayment was made, was not at fault;
(b) the beneficiary against whose benefit the recovery would be, was not the recipient of the overpayment and did not benefit in any way from it;
(c) the beneficiary relying on the Fund, and on the basis of reasonable grounds for believing that he was entitled to that, caused overpayment, incurred irreversible financial obligations or relinquished a valuable right.
PART VIII
PROCEDURAL REQUIREMENTS, ADMINISTRATIVE REVIEW AND DETERMINATION (regs 53-58)
53. Notification of requirements to beneficiary
At the time of making payment of a benefit, the Fund shall notify the beneficiary–
(a) of all requirements that apply in relation to the benefit; and
(b) that the beneficiary shall be at fault if the Fund makes an over-payment that results from his failure to comply to any of his relevant requirements.
54. Beneficiary obligations
(1) A beneficiary is required to comply with periodic requests by the Fund to provide information on matters specified under regulation 38 within fourteen days of the occurrence of the event specified under that regulation.
(2) An insured person or any other person with a material interest in a decision shall have the right to a fair, timely and impartial review of any determination by officers of the Fund who shall have no role in the determination of the case on appeal.
55. Rights of insured person
(1) When notifying a claimant or other petitioner of any action or decision, the Fund shall advise the claimant or other petitioner of the right of administrative review, appeal to the Appeals Tribunal or to court.
(2) An insured person or any other person with a material interest in a decision shall have the right to a fair, timely and impartial review of any determination by officers of the Fund who shall have no role in the determination of the case on appeal.
56. Request for review
(1) For the purpose of this regulation, “review” means administrative review.
(2) A claimant is dissatisfied with an initial determination on a claim about entitlement to a benefit or other matters has a right to request a review by the Director-General.
(3) The petitioner shall file a written request which shall include–
(a) his full name, and membership card number;
(b) the grounds on which he disputes the previous determination or decision;
(c) a statement of any additional evidence to be submitted and the date of submission; and
(d) the name and address of the person he designated as his representative, if any.
(4) The petitioner shall file the request at the headquarters office or at any regional office within sixty days from the date of receipt of the determination.
57. Decision in writing
The Director-General shall inform the petitioner in writing on the conclusions reached in the determination, the reasons and effect of such determination.
58. Advance notice
The Fund shall give the beneficiary a written notice of intent to discontinue or modify payment within sixty days in advance of the effective date of the charge.
PART IX
RECORDS (regs 59-66)
59. Records of earnings
The Fund shall keep record of all contributions–
(a) made by and on behalf of each employee contributing to the Fund, and of all payments made on the earnings record of each employee;
(b) made by contributing employers and the identity of those on whose behalf each such employer has made contributions.
60. Access to records
(1) Every insured person and contributing employer shall have the right to review and obtain copies of all their records maintained by the Fund.
(2) A person who is related to a deceased insured person on whose benefit he would be eligible to receive may review and obtain copy of the contents of the deceased person’s record.
61. Statement of earnings and estimate of benefits
The Fund shall provide to any insured person who requests an estimate of social security benefits and statement of his earning records.
62. Request of record
A person requesting to review a record shall–
(a) make the request at a social security office; or
(b) identify himself by signature, or by the provision of social security identity card or by other means as will provide sure means of identification.
63. Correction of records
(1) The Fund shall correct or amend any record where an employee or an employer shows upon presentation of evidence that the record is incomplete, untimely, or in error.
(2) If the Fund determines that there is no error in the record, it shall–
(a) advise the person the reasons for the refusal to change;
(b) inform the person of his right to request a review of the denial and how to request such review.
64. Records maintained by the employer
(1) The employer shall in every year provide to each employee a report showing –
(a) the employee’s total wages and pensionable earnings for the contribution period;
(b) the employee’s contribution for the year;
(c) the employer’s contribution for the year.
(2) Every contribution employer shall maintain a record showing for each employee who he has engaged–
(a) the dates on which the employee started and finished employment;
(b) the date and amount of each payment of earnings to the employee;
(c) the amount of each monthly employer’s contribution to the Fund in respect of the employee; and
(d) the amount of each monthly employee’s contribution made to the Fund.
65. On site review of records maintained by employers
An inspector appointed under the Act shall review periodically at any reasonable time, the contributing employers’ source records on which the employee’s earnings and contribution reports are based and any other form of information relating to liability to register or to contribute under the Act.
66. Obstruction
Any person who obstructs an authorised inspector or designated official of the Fund in the conduct of an onsite review or otherwise in the lawful exercise of his functions under the Act or these Regulations commits an offence and is liable on conviction to a fine not exceeding one hundred thousand shillings or to imprisonment for a term not exceeding two years or to both that fine and imprisonment.
PART X
GENERAL PROVISIONS (regs 67-75)
67. Minimum pension
Every insured person who on attaining pensionable age and had made 180 contributions but the amount calculated as his pension is lower than 80% of the minimum wage, that person shall be paid 80% of the statutory minimum wage as his monthly pension.
68. Lump sum payment
Where an insured person qualifies for a pension he shall be paid the lump sum amount specified under section 37 of the Act for the month following the month of retirement; and a monthly pension for subsequent months.
69. Reduced pension
Any insured person who claims for early retirement pension under section 27 of the Act shall have his pension amount reduced by 0.5 per centum of the monthly average earnings for every twelve months between the retirement date and the date of attaining the pensionable age.
70. Late entrants
Any insured person, who at the commencement of the Act, will be having less than fifteen years of employment before attainment of pensionable age and on attaining such age his contributing credits are less than 180, may receive a basic pension for a shorter qualifying period as may be determined by the Director-General.
71. Signing of forms and documents
Where any form or document relating to the Fund is required to be signed by an insured person, it shall–
(a) in all cases invariably be marked with the impression of the right thumb of the insured person, or, if impression of the right thumb cannot for any reason be taken, by the impression of the left thumb, or if neither impression can be taken, by such other impression or mark as the Director-General may direct;
(b) be signed in writing, where the insured person is capable of signing in writing; and
(c) in the case of Form NSSF.3 be witnessed and signed by the employer or his representative.
72. Incomplete or inaccurate documents
(1) If in the opinion of the Director-General any document required to be completed under these Regulations in incomplete or inaccurate or is insufficiently clear to identify the person concerned he may return the document to the sender.
(2) The sender shall comply with all lawful directions given to him and shall, within one week of the receipt by him of the document complete and deliver a fresh document in place of it or return the original document duly corrected as the case may require.
73. Duty of employees
Every employee shall furnish to his employer all information and produce any document necessary for the completion of any form or return prescribed by these Regulations and required to be made by his employer.
74. Discretion as to classification
The Director-General shall have a discretion, in the case of employees whose wages consist of remuneration falling under two or more of paragraph (a), (b) or (c) contained in the definition of wages in section 2 of the Act, to treat the amounts falling under only one or two or more of the paragraphs, as the wages of the employee.
75. Revocation
[Revokes the National Provident Fund (General) Regulations, 1964 and the National Provident Fund (Registration of Employees and Contributing Employers) Order.]
SCHEDULE
FORMS
FORM NSSF. 1
APPLICATION FOR EMPLOYER'S REGISTRATION
THE UNITED REPUBLIC OF TANZANIA
NATIONAL SOCIAL SECURITY FUND
(NSSF)
NSSF | |||||
APPLICATION FOR EMPLOYER'S REGISTRATION |
|||||
This form must be submitted to the nearby NATIONAL SOCIAL SECURITY FUND OFFICE (NSSF) |
|||||
1. | Full name of the Employer | FOR OFFICIAL USE ONLY |
|||
2. | Postal Box Number | REGIONAL CODE ................................ |
|||
Telephone Number | DISTRICT CODE .................................. |
||||
Fax Number | INDUSTRIAL CODE .............................. |
||||
3. | Business Registration Certificate | SECTOR CODE ................................... |
|||
(i) Reference Number | |||||
(ii) Date Issued | |||||
4. | Nature of Business (State in detail the type of Business) | EMPLOYER'S NUMBER ....................... |
|||
.................................................................................. | LIABILITY DATE |
||||
.................................................................................. | MONTH YEAR |
||||
5. | Place where the business is carried on | ||||
(i) Region | |||||
(ii) Location | |||||
(iii) Street | |||||
6. | Date from which liable to pay contributors | DATE RECEIVED |
|||
DAY MONTH YEAR |
|||||
7. | Present total Number of Employees | ||||
8. | Number of current/present Employees in branches (if any) | ||||
Branch | Postal Address | Telephone Number | Fax Number | ||
9. | Mode of Wage Payment (Tick where applicable) | ||||
(i) Centrally | |||||
(ii) In Branches | |||||
10. | Declaration | ||||
I hereby CERTIFY THAT: | |||||
(i) The Information given above are correct, accurate, valid and true. | |||||
(ii) I will complete and submit employee's registration cards in respect of all employees. | |||||
(iii) I understand that I'm obliged to comply with the NSSF regulations relating to the payment of contribution and in full and will contribute accordingly. | |||||
Full Name .......................................................................... | CHECKED BY: ..................................... |
||||
Designation ....................................................................... | REMARKS: .......................................... |
||||
Signature and official stamp ................................................ EMPLOYER'S OFFICIAL STAMP | KEYED BY: ......................................... |
||||
Date ............................................... | DATE |
||||
DAY MONTH YEAR |
FORM NSSF. 2
NOTIFICATION TO CONTRIBUTING EMPLOYER
ON REGISTRATION NUMBER
THE UNITED REPUBLIC OF TANZANIA
NATIONAL SOCIAL SECURITY FUND
THE NATIONAL SOCIAL SECURITY FUND ACT
NSSF | National Social Security Fund |
||
Ref. No. NSSF/ ................................................... |
|||
To: ..................................................................... |
|||
With reference to your application form (Form: NSSF.1) to be registered as an employer under the above mentioned Act, you have now been registered and your registration number is .......................... which should be quoted in all correspondence with the Fund. |
|||
I enclose ................... NSSF.3A cards for completion by you and your employees and you are obliged to return them within one month so that the employees can be registered. |
|||
................................................................................. |
|||
Copy: Director of Compliance, |
FORM NSSF. 2
UFAHAMISHO KWA MWAJIRI
KUHUSU NAMBARI YA UANDIKISHAJI
JAMHURI YA MUUNGANO WA TANZANIA
SHIRIKA LA TAIFA LA HIFADHI YA JAMII
SHERIA YA TAIFA YA HIFADHI YA JAMII
NEMBO YA | Shirika la Taifa la Hifadhi ya Jamii |
||
Kumb. Na. NSSF/ ............................................... |
|||
KWA: .................................................................. |
|||
Kutokana na maombi ya uandikishaji uliyoleta (Fomu: NSSF.1) yaliyo chini ya sheria iliyotajwa hapo juu, nakujulisha kwamba sasa umeandikishwa na nambari yako ni .............................. ambayo unatakiwa kuinukuu kila unapofanya mawasiliano na ofisi ya Hifadhi ya Jamii. |
|||
Naambatanisha kadi ........................ Za uandikisjaji (Fomu: NSSF.3A) ambazo unapaswa kuzijaza kwa usahihi pamoja na wafanyakazi wako, na unalazimika kuhakikisha unazirudisha katika kipindi cha mwezi mmoja ili wafanyakazi hao waweze kuandikishwa. |
|||
........................................................ |
|||
Nakala: Mkurugenzi wa Matekelezo, |
FORM NSSF. 3A
MEMBER'S REGISTRATION CARD
NAME | DATE | NSSF | Relationship To | Sex | Permanent Address |
Please note: You are required to provide true information; any false declaration will make you liable to prosecution. |
PART III
LEFT THUMB PRINT | RIGHT THUMB PRINT | ||
PART IV
ATTESTING WITNESS (those in benefit)
The following qualified witness attests to the completion of this form: |
(a) Lawyer/Magistrate/Judge/Advocate |
(b) Senior Public/Civil Servant Officer |
(c) Employer or his Representative |
I certify that the completion of this form was supervised by me and that the thumb prints and signature on the form are of the members. |
Name | Title | Address | Signature |
|
BACK
FOR OFFICIAL USE ONLY |
1. Please be informed that the application for membership duplicate card has been approved. Kindly receive card for the above mentioned insured person. |
2. Please be informed that the application for membership duplicate card has not been honoured for the following reasons: |
.................................................................................................................................. |
Name ............................... Designation ........................... Signature ............................ Date ................................ |
BACK
FORM NSSF. 3B
MEMBER’S RECORD UPDATE AND APPLICATION
FOR MEMBERSHIP DUPLICATE CARD
NATIONAL SOCIAL SECURITY FUND
(NSSF) |
(Please tick were applicable) |
|||
NSSF Membership No. ................................ | |||
Member's Record Update | Membership Duplicate Card |
||
| Application for |
||
| |||
INSTRUCTIONS FOR COMPLETING THIS FORM |
|||
PART I
DESCRIPTIONS | FIRST NAME | MIDDLE NAME | SURNAME |
|||
MEMBER'S NAME | ||||||
PREVIOUS NAME OR MAIDEN NAME |
||||||
CONTACT | CURRENT | PERMANENT |
||||
SEX | MALE | 1 FEES PAID | DATE | |||
FEMALE | RECEIPT NO: | DATE | ||||
MARITAL | SINGLE | MARRIED | SEPARATED | DIVORCED | WIDOW | WIDOWER |
NOTICE 1. Keep this card safely and show it to a new employer. 2. Please do not register more than once to avoid unnecessary inconvenience. 3. Please come with this card while you visit any NSSF office. ZINGATIA 1. Tunza kadi hii kwa usalama na umwonyeshe mwajiri mpya mara tu unapoajiriwa nae. 2. Tafadhali usijiandikishe zaidi ya mara moja ili kuepusha usumbufu hapo baadae. 3. Tafdhali njoo na kadi hii kila unapotemebelea ofisi ya NSSF. |
BACK OF THE CARD
(NYUMA YA KADI)
FORM NSSF. 4
MEMBERSHIP CARD
UNITED REPUBLIC OF TANZANIA
(JAMHURI YA MUUNGANO WA TANZANIA)
NATIONAL SOCIAL SECURITY FUND
(SHIRIKA LA TAIFA LA HIFADHI YA JAMII)
| ||||
MEMBERSHIP CARD |
||||
................................................. | MEMBER'S | |||
NSSF Number: .............................................. |
||||
Date Issued ................................................... |
||||
FRONT
(MBELE)
FORM NSSF. 5
NOTICE FOR REGISTRATION OF EMPLOYEES
NATIONAL SOCIAL SECURITY FUND (NSSF)
EMPLOYEES' REGISTRATION NOTICE |
Regional Director/District Fund Manager |
Ref. No. NSSF/ ............................................... |
Please be informed that a total number of your ......................... employees listed below have been registered as Insured Persons. Their respective membership numbers are as indicated on the right hand columns. |
NAMES OF INSURED PERSONS | NSSF NUMBER |
|||||||
Together with this letter, I’m enclosing ............................ membership cards and you are requested to distribute them to the respective Insured Persons. |
You are required to quote their respective membership number in all transactions with any NSSF Office. |
Name: .................................................... |
FORM NSSF/B. 1
APPLICATION FOR OLD AGE AND INVALIDITY PENSION
NATIONAL SOCIAL SECURITY FUND
|
(TO BE COMPLETED BY THE RETIRED OR AN INVALID INSURED PERSON IN CAPITAL LETTERS) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. |
A. PARTICULARS OF AN INSURED PERSON |
1. NSSF Registration Number ............................................................................... 2. Surname ......................................................................................................... 3. Other names ................................................................................................... 4. Previous/Maiden names ................................................................................... 5. Father’s Name ................................................................................................. 6. Mother’s Name ................................................................................................ 7. Nationality/Tribe ........................................................ Sex ............................... 8. Date of Birth: Day ............................ Month ....................... Year ...................... 9. Permanent/Address ......................................................................................... ....................................................................................................................... ....................................................................................................................... |
B. MEMBERSHIP PARTICULARS: |
1. Date joined the Scheme ................................................................................... 2. Place .............................................................................................................. 3. Date of Retirement/Invalidity .............................................................................. 4. Cause of Invalidity ............................................................................................ 5. Reason for Retirement: (Please tick the appropriate) (i) Attainment of pensionable age [ ] (ii) Early Retirement [ ] (iii) Change from Invalidity Pension [ ] |
6. Name and Address of last Employer: ....................................................................................................................... ....................................................................................................................... |
C. INSURED PERSON’S EMPLOYMENT RECORD |
(i) ..................................... From ................................ To ................................... (ii) ..................................... From ................................ To ................................... (iii) ..................................... From ................................ To ................................... If worked with more than 3 employers provide attachment. |
D. OTHER CLAIMS LODGED BY THE MEMBER |
Have you ever applied for or are you in receipt of any benefit under NSSF? If Yes, state: (i) Type of Benefit ................................................................................................ (ii) Date lodged .................................................................................................... (iii) Office lodged ................................................................................................... (iv) Amount of Benefit ............................................................................................ (v) Other Comments ............................................................................................. |
E. DOCUMENTS TO SUPPORT THE CLAIM |
I attach the following documents depending on type of claim (Please tick): (i) Membership card [ ] (ii) Birth certificate/Medical form for Age [ ] (iii) Medical certificate of Invalidity [ ] (iv) Certificate of Retirement/Termination [ ] |
F. PAYMENT INSTRUCTION: |
Please pay my benefit cheque (i) Through ........................................................ Bank ............................. Branch Account No. ............................................... town ........................................ or (ii) To be collected at NSSF office ...................................................................... or (iii) To be posted to the following address ................................................................ ...................................................................................................................... |
G. DECLARATION OF APPLICANT: |
I declare that the Statements given in this form are true to the best of my knowledge and belief. |
.......................................... Date .................................. | [ ] Right hand [ ] Left hand |
Signature of Attesting Witness 1 FOR OFFICIAL USE: |
H. PENSIONS OFFICE DECISION |
Comments by an authorising officer ............................................................................. ................................................................................................................................. Name: ....................................................................................................................... Designation: .............................................................................................................. Signature: ................................................................................................................. Date: ........................................................................................................................ Approved by: ............................................................................................................. Name: ...................................................................................................................... Designation: .............................................................................................................. Signature: .................................................................................................................. Date: ......................................................................................................................... |
FORM NSSF/B. 2
APPLICATION FOR SURVIVOR'S PENSION
NATIONAL SOCIAL SECURITY FUND
|
(TO BE COMPLETED BY THE DEPENDANT OF THE DECEASED INSURED PERSON IN CAPITAL LETTERS) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation or produce or causes to be produced or furnished any document or information which he knows to be false in material particular is guilty of an offence under the National Social Security Fund Act *. |
A. PARTICULARS OF A DECEASED INSURED PERSON |
1. Surname ......................................................................................................... 2. Other Names ................................................................................................... 3. Father's Name .................................................................................................. 4. Mother's Name ................................................................................................. 5. Nationality/Tribe ............................................................................................... 6. Death certificate No. ......................................................................................... 7. Date of Death ................................................................................................... 8. Place of Birth ................................................................................................... 9. NSSF Registration No. ...................................................................................... 10. Name of the last Employer ................................................................................ 11. Registration number of the last Employer ............................................................ |
B. CLAIMANT'S PARTICULARS: |
1. Surname 2. Other Names 3. Date of Birth: Day .......................... Month ............................. Year ................ 4. Place of Birth .................................................................. Sex ....................... 5. NSSF Registration No. (If any) ......................................................................... 6. Address: ..................................................................................................... ..................................................................................................... ..................................................................................................... 7. Relationship with deceased insured person ....................................................... 8. Nationality/Tribe ............................................................................................. In case of polygamous marriage, please list the spouses: |
C. PARTICULARS OF SURVIVING CHILDREN |
1. Name of children who are under the age of 18 or 21 years if receiving full time education |
Name in Full | Date of Birth | Place of Birth | Address | Occupation |
D. OTHER CLAIMS LODGED BY THE INSURED PERSON |
Have you ever applied for or are you in receipt of any benefit under NSSF? IF YES, State: (i) Type of benefit ................................................................................................. (ii) Date of Lodged ................................................................................................. (iii) Office Lodged ................................................................................................... {mprestriction ids="1,2,3"} (iv) Amount of benefit .............................................................................................. (v) Other comments ............................................................................................... |
E. DOCUMENTS TO SUPPORT THE CLAIM |
I attach the following documents to support my claims: (i) Photocopies and Birth certificates (if claimant is a child of deceased). (ii) Certification from school/college i.e. those above 18 as regards schooling. (iii) Marriage certificate (if the claimant is a spouse). (iv) Death certificate (or any other document to support occurrence of death) of the insured person. (v) Medical certificate for children suffering from permanent invalidity. |
F. PAYMENT INSTRUCTION: |
Please pay my benefit cheque: (i) Through ................................ Bank ................... Branch Account No. ................ (ii) To be collected at NSSF office ....................................................................... or Town ...................................... or (iii) To be posted to the following address ................................................................. ........................................................................................................................ ........................................................................................................................ |
G. DECLARATION OF APPLICANT |
I declare that the statements given in this form are true to the best of my knowledge and belief. |
......................................................... | .............................................. Right Hand |
Date ............................................ | ................................................ Left hand |
......................................................... (Only necessary if applicant is unable to write) Date ................................................. FOR OFFICIAL USE |
H. PENSIONS OFFICE DECISION |
Comments by an authorising officer .................................................................. .................................................................. .................................................................. Designation: ............................................... Official stamp: ............................................ Date: ......................................................... Approved by: .............................................. Name: ....................................................... Designation: .............................................. Signature: ................................................. Date: ........................................................ |
FORM NSSF/B. 3
APPLICATION FOR FUNERAL/GRANT
NATIONAL SOCIAL SECURITY FUND
|
(TO BE COMPLETED BY AUTHORISED MEMBER OF THE FAMILY OF THE DECEASED INSURED PERSON) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation or produce or causes to be produced or furnished any document or information which he knows to be false in material particular, is guilty of an offence under the National Social Security Fund Act *. |
A: PARTICULARS OF A DECEASED INSURED PERSON |
1. Surname: ........................................................................................................ 2. Other Names: .................................................................................................. 3. Previous/Maiden Names: .................................................................................. 4. Father’s Name: ................................................................................................ 5. Mother’s Name: ............................................................................................... 6. Nationality/Tribe: .............................................................................................. 7. Death Certificate Number: ................................................................................. 8. Date of Death: .................................................................................................. 9. NSSF Registration Number: .............................................................................. 10. Number of the last Employer: ............................................................................ 11. Number of the last Employer: ............................................................................ |
B. CLAIMANT'S PARTICULARS |
1. Surname: ........................................................................................................ 2. Other Names: .................................................................................................. 3. Date of Birth: ................................................................................................... 4. Nationality/Tribe: .............................................................................................. 5. Place of Birth: .................................................................................................. 6. NSSF Registration No. (If any): .......................................................................... 7. Address: .......................................................................................................... ....................................................................................................................... 8. Relationship with a deceased insured person ...................................................... |
C. DOCUMENTS TO SUPPORT THE CLAIM |
I attach the following document to support my claim: (i) Certificate for the death of the deceased insured person or certificate from ward secretary certifying occurrence of the death. (ii) Receipt for the amount of funeral expenses. (iii) Agreement of the family of the deceased for the nominated claimant for funeral grant. |
D. PAYMENT INSTRUCTIONS |
Please pay my benefit cheque: Through .............................................. Bank .......................... Branch ........................ (i) To be collected at NSSF office ....................................................................... or (ii) To be posted to the following address ................................................................. ........................................................................................................................ ........................................................................................................................ |
E. DECLARATION OF APPLICANT |
I declare that the statements given in this form are true to the best of my knowledge and belief. |
............................................... | ...................................... Right Hand |
Date ....................................... | ........................................ Left Hand |
............................................... |
FOR OFFICIAL USE |
F. PENSIONS OFFICE DECISION |
Comments by an authorising officer ............................................................................. ................................................................................................................................. ................................................................................................................................. Name: ....................................................................................................................... Designation: .............................................................................................................. Date: ......................................................................................................................... Approved by: ........................................................... Name: ................................................................... Designation: ........................................................... Signature: .............................................................. Date: ..................................................................... |
FORM NSSF/B. 4
APPLICATION FOR MATERNITY BENEFIT
NATIONAL SOCIAL SECURITY FUND
Member |
(TO BE COMPLETED IN CAPITAL LETTERS BY A FEMALE MEMBER EXPECTING DELIVERY) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation or produce or causes to be produced or furnished any document or information which he knows to be false in material particular, is guilty of an offence under the National Social Security Fund Act *. |
A. PARTICULARS OF AN INSURED PERSON |
....................................................................................................................... |
B. MEMBERSHIP PARTICULARS: |
1. Date joined the Scheme .................................................................................. 2. Place ............................................................................................................. 3. Name of last Employer .................................................................................... 4. Address of last Employer ................................................................................. ...................................................................................................................... ...................................................................................................................... |
C. INSURED PERSON’S EMPLOYMENT RECORD |
(i) ....................................... From ............................ To ......................... (ii) ....................................... From ............................ To ......................... (iii) ....................................... From ............................ To ......................... If worked with more than 3 employers provide attachment. If No, mention your last employer |
D. OTHER CLAIMS LODGED |
1. Have you ever applied for or have you received maternity benefits within the past three years? 2. Have you ever applied for or are you in receipt of any benefit under NSSF? If YES state: (i) Type of benefit ......................................................................................... (ii) Date Lodged ............................................................................................ (iii) Office Lodged ........................................................................................... (iv) Amount of benefit ..................................................................................... (v) Other comments ...................................................................................... |
E. DOCUMENTS TO SUPPORT THE CLAIM |
I attach the following documents to my claim: (i) Membership card. (ii) Medical certificate of expected confinement. (iii) Death certificate if child died within the period of twelve months. (iv) Certificate to support the case of still birth. (v) Certificate/Forms to support prolonged post-natal care. |
F. PAYMENT INSTRUCTION: |
Please pay my benefit cheque: (iv) Through .................................................. Bank .................................. Branch Account No. ........................................................ town .............................. or (v) To be collected at NSSF office ..................................................................... or (vi) To be posted to the following address ............................................................... ..................................................................................................................... |
G. DECLARATION OF APPLICANT: |
I declare that the statements given in this form are true to the best of my knowledge and belief. |
.................................................. | ................................................. Right hand |
Date .......................................... | .................................................... Left hand |
.................................................. (only necessary if the applicant is unable to write) Date: ............................................... FOR OFFICIAL USE |
H. PENSIONS OFFICE DECISION |
Comments by an authorising officer ............................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. ................................................................................................................................. Name: ...................................................................................................................... Designation: .............................................................................................................. Signature: ................................................................................................................. Date: ........................................................................................................................ ................................................................................................................................. |
FORM NSSF/B. 5
APPLICATION FOR EMPLOYMENT INJURY AND OCCUPATIONAL DISEASE BENEFIT
NATIONAL SOCIAL SECURITY FUND
Member |
(TO BE COMPLETED BY AN INSURED PERSON WHO SUSTAINED INJURY OR CONTRACTED AN OCCUPATIONAL DISEASE) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation or produce or causes to be produced or furnished any document or information which he knows to be false in material particular, is guilty of an offence under the National Social Security Fund Act *. |
A: PARTICULARS OF A DECEASED INSURED PERSON |
1. Surname: ........................................................................................................ 2. Other Names: .................................................................................................. 3. Previous/Maiden Names: .................................................................................. 4. Father’s Name: ................................................................................................ 5. Mother’s Name: ............................................................................................... 6. Nationality/Tribe: .............................................................................................. 7. NSSF Registration Number: .............................................................................. |
B. MEMBERSHIP PARTICULARS: |
1. Date joined the Scheme .................................................................................... 2. Place .............................................................................................................. 3. Usual occupation of the claimant ....................................................................... 4. Name of the last employer ................................................................................ 5. Number of the last employer ............................................................................. 6. Address .......................................................................................................... |
C. INSURED PERSON’S EMPLOYMENT RECORD |
(i) ....................................... From ......................... To ......................... (ii) ....................................... From ......................... To ......................... (iii) ....................................... From ......................... To ......................... If worked with more than 3 employers provide attachment. If No, mention your last employer 1. ....................................... From ......................... To ......................... 2. ....................................... From ......................... To ......................... |
D. OTHER CLAIMS LODGED BY THE MEMBER |
Have you ever applied for or are you in receipt of any benefit under NSSF? State: (i) Type of benefit ......................................................................................... (ii) Date Lodged ............................................................................................ (iii) Office Lodged ........................................................................................... |
E. EMPLOYMENT INJURY ACCIDENT/OCCUPATIONAL DISEASE |
1. State briefly how the accident/occupational disease occurred ..................................................................................................................... 2. Where did the accident happen or the occupational disease detected ..................................................................................................................... 3. When did the accident happen or the occupation disease detected .................... 4. Describe the Injury you sustained as a result of accident or the disease you contracted as a result of the activity in a specific occupancy .............................. 5. When did you report the case of accident or occupational Disease to your employer |
F. DOCUMENTS TO SUPPORT THE CLAIM |
I attach the following document to support my claim (i) Membership card ........................................................................................... (ii) Certificate of Medical Board for Temporary, Permanent Disability or Occupational Disease of an insured person. |
G. PAYMENT INSTRUCTIONS |
Please pay my benefit cheque (i) Through .................................. Bank ............................ Branch ....................... (ii) To be collected at NSSF office ...................................................................... or (iii) To be posted to the following address ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... |
H. DECLARATION OF AN APPLICANT |
I declare that the statements given in this application form are true to the best of my knowledge and belief. |
................................................ | ............................................ Right Hand |
Date ........................................ | ................................................ Left Hand |
................................................. |
I. DECLARATION OF THE LAST EMPLOYER |
This is to certify that Mr/Mrs/Miss ........................................ with registration number ........................................ was our employee and he has been contributing to the Fund he/she is not covered under workman’s compensation, I confirm that he/she sustained injury/contracted occupational disease while performing his/her daily duties. Name of Employer ................................................................ Employer Number ................................................................. Name of certifying officer ....................................................... Designation ......................................................................... Official Stamp ...................................................................... Date ................................................................................... |
FOR OFFICIAL USE |
J. PENSIONS OFFICE DECISION |
Comments by an authorising officer ............................................................................ ................................................................................................................................ ................................................................................................................................ Name: ........................................................................ Designation ................................................................ Signature ................................................................... Date .......................................................................... |
FORM NSSF/B. 6
NOTIFICATION FOR SICKNESS
NATIONAL SOCIAL SECURITY FUND
|
(TO BE COMPLETED BY AN INSURED PERSON IN CAPITAL LETTERS) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. |
A. PARTICULARS OF AN INSURED PERSON |
1. NSSF Registration Number ................................................................................ 2. Surname .......................................................................................................... 3. Other names .................................................................................................... 4. Previous/Maiden names .................................................................................... 5. Father’s Name ................................................................................................. 6. Mother’s Name ................................................................................................ 7. Nationality/Tribe .................................................................. Sex ..................... 8. Date of Birth: Day ............................... Month ............................... Year .......... 9. Permanent/Address ......................................................................................... ....................................................................................................................... ....................................................................................................................... |
B. PARTICULARS OF A PATIENT (Other than Insured person): |
1. Name in full .................................................................................................... 2. Relationship with insured person ...................................................................... 3. SEX: Male/Female .......................................................................................... 4. Date of Birth: Day ....................... Month .............................. Year ................... 5. Nationality/Tribe .............................................................................................. 6. Address: ........................................................................................................ ...................................................................................................................... ...................................................................................................................... |
C. NOTIFICATION FOR RECEIVING TREATMENT: |
(i) I wish to inform you that I am going to receive treatment at ................................ Hospital where my family and I are entitled to receive medical attention. According to NSSF regulations I am left with ........................................ days to which I am entitled for the period of ........................................ (ii) I wish to inform you that my dependant has gone for medical attention at ................................................................................ hospital. My dependants are |
..................................................... | ................................... Right hand |
........................................... | ..................................... Left hand |
D. DECLARATION OF THE EMPLOYER: |
I certify that the member/family member show particulars are shown in part A and B of this form is an employee/family member of employee of that company/Institution and therefore is known to me. The particulars presented are correct and his contributions for the past ........................................ months/years have been paid in accordance with NSSF regulations. Name of employer ..................................................................................................... Employer number ...................................................................................................... Name of certifying officer ............................................................................................ Designation ............................................................................................................... Signature .................................................................................................................. Official stamp ............................................................................................................ Date ......................................................................................................................... |
E. MEDICAL PRACTITIONER CERTIFICATION: |
This is to certify that Mr./Mrs./Miss 2 ......................................................................... NSSF registration ............................................................................. /Family member Mr./Mrs./Miss ....................................................................... was attended as follows: (i) Treatment ................................................................................................ Duration .................................................................................................. (ii) Admission ............................................................................................... (iii) Other remarks: ......................................................................................... Name of Medical Practitioner .................................................................... Signature ................................................................................................. Official Stamp .......................................................................................... Date ........................................................................................................ Note: To be filled in triplicate viz: FOR OFFICIAL USE NSSF officer’s decision .................................................................................................. Name: .......................................................................................................................... Designation ................................................................................................................... Signature: ..................................................................................................................... Date: ............................................................................................................................ |
FORM NSSF/B. 7
REQUEST FOR CERTIFICATION OF INSURED PERSON’S AGE
NATIONAL SOCIAL SECURITY FUND
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. |
The Medical Practitioner ............................................................................................................... ............................................................................................................... Mr./Mrs./Miss 1 .................................... NSSF Registration No ................ The above named person has retired from employment due to age and apparently he/she does not have a birth certificate or an affidavit. Please examine the member to ascertain his/her age and complete the certificate below: Name ........................................................................................... Signature ...................................................................................... Official Stamp ................................................................................ Date ................................ |
CERTIFICATION FOR ASCERTAINMENT OF AGE (To be completed by a qualified Medical Practitioner) |
Mr./Mrs./Miss ................................................. NSSF Registration No. .................... I hereby certify that I have examined the member ....................................... and in my opinion he/she has attained the age of ................................. as at (date) ....................... Name ............................................................................................................ Signature ....................................................................................................... Official Stamp ................................................................................................. Date .............................................................................................................. |
FORM NSSF/B. 8
REQUEST FOR MEDICAL EXAMINATION OF AN
INSURED PERSON FOR INVALIDITY/EMPLOYMENT
INJURY/OCCUPATIONAL DISEASE
NATIONAL SOCIAL SECURITY FUND
National Social Security Fund. |
REF. No. NSSF/ ......................................... Date ........................................ 20....... WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. The Medical Practitioner ................................................................................................................................ ................................................................................................................................ MEDICAL EXAMINATION OF AN INSURED PERSON Insured Person’s name: Mr./Mrs./Miss 1 ..................................................................... NSSF Registration number ........................................................................................ The above-named person has a claim for invalidity benefit/employment/occupational disease under the National Social Security Fund Act *. I shall be grateful if you will examine and report on the degree of disability/injury/occupational disease so that I may decide on his claim of benefit. REGIONAL DIRECTOR/REGIONAL DISTRICT FUND MANAGER Name ..................................................................................................................... Designation ............................................................................................................. Signature ................................................................................................................ Date ....................................................................................................................... |
FORM NSSF/B. 9
MEDICAL CERTIFICATE IN SUPPORT OF
APPLICATION FOR INVALIDITY/EMPLOYMENT
INJURY/OCCUPATIONAL DISEASE
(To be completed by the Medical Board of the National Social Security Fund in capital letters) |
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. Insured Person’s name: Mr./Mrs./Miss 1 .................................................................... NSSF Registration number ........................................................................................ I hereby certify that I have examined the person and found that he/she is ............................................................................................................................... ............................................................................................................................... ..............................................................................................................................., (STATE NATURE OF ILLNESS) a disablement which is likely to remain Temporary/Permanent. In my opinion he/she is temporarily/permanently incapable/invalid of work as a result of this disablement. Doctor’s remarks ..................................................................................................... ............................................................................................................................... ............................................................................................................................... ............................................................................................................................... Name: ..................................................................................................................... Designation .............................................................................................................. Signature ................................................................................................................. Date ........................................................................................................................ OFFICIAL SEAL |
FORM NSSF/B. 10
CERTIFICATE OF EXPECTED CONFINEMENT
NATIONAL SOCIAL SECURITY FUND
WARNING: Any person who for the purpose of obtaining any benefit for himself or some other person makes any false statement or representation, or produces or furnishes or causes to be produced or furnished any document or information which he knows to be false in material particular, commits of an offence under the National Social Security Fund Act *. Full name of an Insured Person ...................................................................................... NSSF Registration Number ............................................................................................ Address: ..................................................................................................................... I hereby certify that I attended the above named person in connection with pre-natal service. She is expecting delivery on the day of ........................ month ........................ year ......... Name: ......................................................................................................................... Designation ................................................................................................................... Signature ...................................................................................................................... Date ............................................................................................................................. |
FORM NSSF/B. 11
AUTHORITY TO RECEIVE MANDATE
NATIONAL SOCIAL SECURITY FUND
INSURED PERSON'S PARTICULARS |
||
Employer's Reg. No. | Insured NSSF No. | Name Insured Person |
To whom it may concern I, the undersigned being an insured person entitled to benefit on the above described account, do hereby authorise: Mr./Mrs./Miss 1 ....................................................................................................... whose signature and thumb impression is hereunder affirmed to receive on my behalf the sum due to me for which sum receipt of the above named person shall be a discharge. As witness my hand this ............................ day of .......................... 20 ....... Signed in the presence of ......................................................................................... Address .................................................................................................................. ........................................................................................................................ ........................................................................................................................ Office or Qualification ................................................................................................ |
............................................................ | ............................................................... |
Receive payment |
............................................. Right Hand | ............................................. Right Hand |
................................................ Left Hand | ............................................... Left Hand |
When the person giving authority cannot read and write, the following certificate should also be signed. I certify that this authority, before being signed by the said ......................................., ....................................................... Date ................................................ |
FORM NSSF/B. 12
BENEFIT COUPON
NSSF EMBLEM | |
NATIONAL SOCIAL SECURITY FUND | (NSSF) |
BENEFIT COUPON | |
Members |
|
Photo |
|
Name in Full ........................................... | |
Type of Benefit ........................................ | Age/Invalidity/Survivors |
Paying Centre ......................................... | |
Paying Centre code Number ..................... | |
Year ....................................................... |
Month | Amount Paid | Cheque No. | Member's | Pension Officers |
Jan. | ||||
Feb. | ||||
Mar. | ||||
Apr. | ||||
May. | ||||
June. | ||||
July. | ||||
Aug. | ||||
Octo. | ||||
Nov. | ||||
Dec. | ||||
NOTE: 1. Bring this coupon whenever you are coming to the NSSF OFFICE FOR PENSION. 2. The coupon is renewable annually. |
(Section 50)
[
G.N. No. 284 of 1999
1. Citation
2. Interpretation
3. Entitlement to maternity benefits
4. Application for maternity benefits
5. Conditions for award of maternity benefits
(a) has made at least thirty six monthly contributions to the Fund, of which twelve contributions were made in the thirty six months immediately prior to the week of expected confinement; and
(b) has a certificate prescribed in Form MB2 as set out in the Schedule, from an accredited medical provider certifying that she expects delivery of a child; or
(c) has delivered a child and has a certificate prescribed in Form MB3 as set out in the Schedule; and
(d) has completed a period of three years from the date of last delivery in respect of which maternity benefits were payable.
6. Notification of entitlement or rejection of benefit
7. Types of maternity benefits
Maternity benefits shall comprise of–
(a) cash maternity benefit; and
(b) medical care benefit.
8. Cash maternity benefit
(a) at the rate of 100 per centum of the average daily earnings calculated by reference to the earnings received during the six months of insurable employment immediately prior to the twentieth week of pregnancy;
(b) subject to deduction of ten per centum being continuing contribution to the Fund by that insured person;
(c) for a maximum of four weeks in the case of a still born child or where the child does not survive beyond forty eight hours;
(d) in a lump sum after confinement:
Provided that where registered medical practitioner certifies that the female insured person should take maternity leave six weeks before confinement, that female insured person may be paid cash maternity benefits for a maximum of four weeks prior to confinement and eight weeks after confinement.
9. Medical care benefit
10. Medical care services
(a) EPH Gestosis (Pre-eclampsia);
(b) Eclampsia;
(c) Gestational Diabetes;
(d) Rhesus Incompatibility;
(e) Anaemia of pregnancy;
(f) Ante partum Haemorrhage; and
(g) Post partum Haemorrhage.
11. Limitation of claims
12. Accreditation of medical care providers
13. Requirements for accreditation
(a) the availability of human resources, equipment and physical structure that is in conformity with the standards set by the Ministry responsible for health matters;
(b) the availability of outpatient and inpatient care under supervision of a qualified medical doctor;
(c) the availability of twenty-four hours nursing services supervised by a registered nurse of the rank higher than nurse midwife;
(d) the acceptance of formal programme of quality assurance and utilisation review;
(e) the acceptance of payments mechanism specified by the Board.
14. Choice of accredited medical care providers
15. Agreements with medical care providers
(a) over-utilisation of medical care services;
(b) under-utilisation of medical care services;
(c) unnecessary diagnostic and therapeutic procedures and interventions;
(d) unnecessary or irrelevant medication prescription;
(e) medical care provider paying cash to beneficiaries in lieu of medical care.
16. Payment mechanism
17. Inspections
18. Reports
SCHEDULE
FORM MB. 1
APPLICATION FOR CLAIM OF MATERNITY BENEFITS
NATIONAL SOCIAL SECURITY FUND
This form is in three parts: Part 1 - For you to complete Part 2 - For your employer to complete Part 3 - For NSSF use only IMPORTANT: This form should NOT be signed and dated before the 20th week of pregnancy. Please use CAPITAL LETTERS throughout. |
Part 1 | INFORMATION ABOUT YOU | |||
Your NSSF | When do you expect | / / | ||
Surname or family name | Mrs./Ms./Miss |
|||
All other names (Given names) in full | ||||
All other family/surnames/maiden names which you have been known by or are using now | ||||
Date of birth | / / | |||
Permanent Address | ||||
Nationality | ||||
Place of birth | ||||
Father's name - in full | ||||
Mother's name - in full | ||||
Details of your NSSF membership | ||||
Date of joining | ......... / ........... / ........... | Office at which you joined NSSF | ||
Employer's details | ||||
Give the name | ||||
Details of previous employer
| Name Employed from ......................... to .................. |
|||
| Name Employed from ......................... to .................. |
|||
| Name Employed from ......................... to .................. |
|||
If you have had more than 3 previous employers, please attach the details to this form: | ||||
Details of other claims which you have previously made to NSSF | Tick appropriate box |
|||
Have you applied for Maternity Benefits within the last three years? | YES NO | |||
If YES, when and where did you claim? | Date (Month and Year) NSSF Office at |
|||
If you have previously claimed any other benefits give the following information: | ||||
Type of benefit | Office where claim made | Date when claim made | Benefit paid for period | Amount if benefit paid |
DOCUMENTS NEEDED IN SUPPORT OF THIS CLAIM | ||||
The following documents must be submitted to NSSF with this claim form - please tick the boxes to show which of them you are attaching to this claim: | ||||
Your original NSSF membership card (NSSF.4) | ||||
Three passport-size photos | ||||
If you had a child which died in the twelve months prior to this claim please provide the Death Certificate | ||||
DOCUMENTS NEEDED LATER When you reach the 24th week of your pregnancy you must have the Certificate of Expected Confinement (Form MB2) completed and then give it to the NSSF office at which you are making this claim. After you give birth, NSSF will require a Certificate of Actual Confinement (Form MB3). If you require prolonged post-natal care after your confinement, a medical certificate will be needed to confirm that the care is directly related to the confinement. |
| ||||
|
|
|||
|
||||
| ||||
|
| |||
|
|
| ||||
|
|||||
FORM MB. 2
CERTIFICATE OF EXPECTED CONFINEMENT
NATIONAL SOCIAL SECURITY FUND
This Certificate must be completed by an Accredited Medical Practitioner and is issued solely for the purpose of accompanying an application to Maternity Benefits by the NSSF member named at Part A below. |
Part A | DETAILS OF THE INSURED WOMAN | ||
Name in full | |||
Address | |||
NSSF Membership Number | Date of Birth | ||
Part B | CERTIFICATION | ||
Note that this certificate must not be issued before the 24th week of pregnancy |
|||
I hereby certify that I have examined the above-named and I confirm that: | |||
1 she is expecting delivery of a child on | |
||
Name of Accredited Medical Practitioner | |||
Designation/Title | |||
Registration number (For Doctor/Midwife) | |||
Signature .............................................. | Date .................................................. |
||
Warning: Any person who, for the purpose of obtaining any benefit for themself or some other person, makes a false statement or representation, or produces or furnishes - or causes to be produced or furnished - any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
|||
Please see Benefit Information overleaf |
BENEFIT INFORMATION A woman who qualifies for Maternity Benefits will be entitled to: |
|
Cash Maternity Benefit - | which will be calculated and paid to the woman by the NSSF Office |
and | |
Medical Care Benefit - | which enables her to receive medical care during the ante- and post-natal periods, and during her confinement. The care will be available from an accredited provider (hospital, clinic, dispensary, etc.) from the 24th week of pregnancy. |
The Medical Care which will be approved and paid for by the NSSF is for treatment for the following: (i) EPH Gestosis (Pre-Eclampsia) (Oedema, Proteinuria, Hypertension) (ii) Eclampsia (iii) Gestational diabetes (iv) Rhesus incompatibility (v) Anaemia of pregnancy (vi) Ante partum haemorrhage (vii) Post partum haemorrhage Because the NSSF can only pay for Medical Care which is required specifically for - and as a direct result of - the pregnancy, any treatment(s) other than those listed above will not be paid for by the Fund. Further information about Maternity Benefits is included in the Provider Information Notes and Maternity Benefits Leaflets which will be given to you by your local NSSF Office. |
FORM MB. 3
CERTIFICATE OF CONFINEMENT
NATIONAL SOCIAL SECURITY FUND
This certificate must be completed by an Accredited Medical Practitioner and is issued solely for the purpose of accompanying a claim to Maternity Benefits by the NSSF member named at Part A below. The completed Certificate should then be submitted, as soon as possible, to the NSSF Office at which the original Maternity benefit claim was made. |
||||||
PART A | DETAILS OF THE INSURED WOMAN | |||||
Name in full | ||||||
Address | ||||||
NSSF Membership Number | Date of Birth | / / |
||||
PART B | CERTIFICATION | |||||
I hereby certify that the above named delivered 1 a male/female child/children ......... (number) 2 which was/were alive at birth/died after 48 hours on the following date: I hereby certify that a stillbirth occurred on: |
|
|||||
Child/ children's full name(s) | ||||||
Delivery number | ||||||
Birth took place at | ||||||
Name of Doctor/ Midwife certifying delivery | ||||||
Registration number (of that Doctor/ Midwife) | ||||||
Signature ........................................... | Date ......................................... | |||||
Warning: Any person who, for the purpose of obtaining any benefit for themself or some other person, makes a false statement or representation, or produces or furnishes - or causes to be produced or furnished - any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM MB. 4
MATERNITY BENEFITS AWARD NOTICE
NATIONAL SOCIAL SECURITY FUND
The NSSF office must attach the claimant's photograph here and then authenticate by over-stamping with the office address stamp |
||||
To: ................................................... ................................................... ................................................... | From the NSSF Office at ....................................................... ....................................................... |
|||
NSSF Membership Number | Phone: .............................................. Fax: .................................................. |
|||
I am pleased to inform you that you will be entitled to Maternity Benefits as follows: |
||||
• Maternity Medical Care This is available to you from the beginning of the 24th week of your pregnancy, that is from ............................... The care will then continue throughout the rest of your pregnancy and end 48 hours after your confinement (seven days after, in the event of a caesarean delivery). See also the notes overleaf which provide further information about Maternity Care Benefit. • Cash Maternity Benefit This will be paid to you in two instalments as follows: |
||||
Amount | Period covered by the payment | Approximate date of payment | ||
............................ | From ............... to ................ | ............. / .......... / ............ | ||
............................ | From ............... to ................ | ............. / .......... / ............ 1 | ||
If you have any questions about the information above - or about the Provider Information overleaf - please don't hesitate to contact us. Note also that there is right of appeal against this decision and, if you need it, more information about the appeals procedure can be obtained from this office. Signature ................................................. Name ........................................ (CAPITALS) Date ...................... NSSF Office Manager IMPORTANT: You must now show this notification to the provider who will care for you. That provider may take a photocopy, or note the details contained in the letter, but must then return it to you to keep. |
||||
PROVIDER INFORMATION |
||||
What is a "Provider"? | It is an accredited hospital, clinic, dispensary or doctor approved by the NSSF. |
|||
Can/may I choose a provider? | The accredited medical provider(s) in your area, from whom you choose to obtain your Medical Care, is as follows: |
|||
........................................... ........................................... ........................................... | ........................................... ........................................... ........................................... | |||
What medical care will NSSF pay for? | NSSF can only pay your chosen provider for treatment given to you for these medical conditions: |
|||
EPH Gestosis (Pre-Eclampsia) (Oedema, Proteinuria, Hypertension) |
||||
If I need treatment which is not included in this list, can I get it? | You will need to discuss and arrange this with the provider but you should be aware that any additional treatment must be paid for by you. |
|||
Can I have further treatment after the 48 hour/7 day period ends? | Only if care is medically necessary and is a direct result of your confinement. However, the maximum period for which the extended care can be paid for by NSSF is twelve (12) weeks. If the care extends beyond the twelve weeks, you will have to pay the cost. |
Note for the Medical Care Provider Please note that this letter is the property of the woman named overleaf and must be returned to her when you have either made a photocopy or made a note of the information thereon. |
FORM MB. 5
NOTICE OF DISALLOWANCE OR REJECTION
NATIONAL SOCIAL SECURITY FUND
To: | From the NSSF Office at |
|||
I am sorry to tell you that your recent claim for Maternity Benefits was not successful and has been disallowed. The reason for this decision is that |
||||
You are not a contributing member of NSSF. |
||||
You have not satisfied the contribution conditions. |
||||
Your application was made more than twelve weeks after your confinement. |
||||
You have failed to provide the documents, certificates or evidence which NSSF asked you for. |
||||
You have not completed a period of 3 years since a previous confinement for which you were paid maternity benefits. |
||||
................................................................................................................. ................................................................................................................. |
||||
At the time of your claim you had only paid ...................... contributions. If, however, you pay a further .............. contributions between the date when you made your claim and your expected week of confinement, please let me know and your claim will be reviewed. |
||||
There is a right of appeal against this decision and if you need more information - about either the decision or your appeal rights - please contact this office. Signature ............................................... Name ........................................... (CAPITALS) Date .............................. NSSF Office Manager |
TABLE OF CONTENTS
Regulation
Title
PART I
PRELIMINARY PROVISIONS
1. Citation.
2. Interpretation.
PART II
BENEFITS
3. Notification.
4. Application for benefits.
5. Conditions for award of benefits.
6. Notification of entitlement to benefits.
7. Benefits.
8. Cash benefit.
9. Artificial limbs.
10. Death benefit.
11. Negligence by an insured person.
12. Time limits for claims to employment injury.
PART III
MEDICAL BOARD AND MEDICAL APPEALS TRIBUNAL
13. Composition and responsibility of the Medical Board.
14. Review of decision of Medical Board.
15. Appeals against a decision of a Medical Board.
16. Powers of the Medical Appeals Tribunal.
17. Decisions of Medical Appeals Tribunal.
18. Procedures of Medical Appeals Tribunal.
19. Fees for lodging an appeal.
20. Remuneration of the Tribunal and Medical Board.
PART IV
MISCELLANEOUS PROVISIONS
21. Measures to improve the welfare of an insured person.
22. Factory inspection.
23. Liability under Workmen's Compensation Act.
SCHEDULES
THE NATIONAL SOCIAL SECURITY FUND (EMPLOYMENT INJURY BENEFITS) REGULATIONS
(Sections 50 and 89)
[1st October, 2002]
G.N. No. 97 of 2002
PART I
PRELIMINARY PROVISIONS (regs 1-2)
1. Citation
These Regulations may be cited as the National Social Security Fund (Employment Injury Benefits) Regulations.
2. Interpretation
In these Regulations, unless the context otherwise requires:
"Act" means the National Social Security Fund Act *;
"accredited medical care provider" means a medical care provider appointed by the Board for purposes of regulation 5(4);
"average daily earnings" means average daily earnings as set out in the First Schedule to these Regulations;
"average monthly earnings" means average monthly earnings as set out in the First Schedule to these Regulations;
"beneficiary" means an insured person who satisfies the conditions for employment injury benefit under the Act;
"benefit" means employment injury or occupational disease benefit;
"Board" means the Board of Trustees of the National Social Security Fund;
"death benefit" means the benefit payable to a dependant in respect of an insured person who dies as a result of an employment injury or an occupational disease;
"Director-General" means the Director-General of the Fund;
"dormant member" means any person who was registered as an insured person under the Fund but the liability to contribute to the Fund has ceased due to operation of law or have ceased to be employed by an employer who is liable to register with the Fund;
"employment injury" means an injury sustained during working hours, at a work place; or at a place where one would not have been except for his employment including commuting accidents when using employer's motor vehicle, motorcycle bicycle, plane, boat, train or ship;
"Fund" means the National Social Security Fund;
"insurable earnings" means the earnings on the basis of which insured person contributions is made;
"insurable employment" means employment as for insured person for an employer who is required to be registered with the Fund;
"insured person" means a person employed in an insurable employment and registered as an insured person under the Act except self employed and dormant member;
"licenced medical practioner" means a medical practioner holding a licence issued by the Tanzania Medical Council;
"medical care provider" includes a dispensary, health centre, hospital or any other medical clinic;
"Medical Board" means a Medical Board appointed by the Minister under section 32 of the Act;
"minor injury" means an injury that arise out of and in the cause of employment but does not prevent the insured person from continuing with his routine work;
"occupational disease" means a disease contracted as a result of exposure to risk factors arising from a particular occupation and which is prescribed in the Third Schedule to these regulations;
"permanent disability" means a disability of an insured person resulting from a work related injury, or an occupational disease which continues beyond the end of the period for which temporary disablement benefit is payable;
"registered medical practitioner" means any person professing to practise medicine or surgery or holding himself out as ready to give medical or surgical treatment to patients for gain;
"temporary disability" means an incapacity of an insured person resulting from work related injury or occupational disease for a limited period of time; that period being a maximum of 26 weeks, commencing with the date of the relevant accident, or date of development of the relevant disease;
"Tribunal" means the Medical Appeals Tribunal.
PART II
BENEFITS (regs 3-12)
3. Notification
(1) Every insured person who sustains personal injury caused by an accident arising out of and in the course of his employment shall give notice of such injury to his employer either in writing or orally as soon as practicable after the accident occurs.
(2) Every insured person who contracts an occupational disease specified in the Third Schedule shall give notice of such disease to his employer either in writing or orally as soon as he has medical evidence of the occupational disease:
Provided that such notice required to be given by an insured person under subregulations (1) and (2) may be given by any other person acting on behalf of the insured person.
(3) The employer of the beneficiary shall notify the Director-General the details of the accident or disease on form EIB 2(A) or EIB 2 (PD) as set out in the Fourth Schedule within a period of fourteen days from the date of receipt of the Form and deliver it at the nearest office of the Fund.
4. Application for benefits
(1) An insured person or any other person acting on his behalf shall apply for employment injury benefits by completing Form EIB 1(A) or EIB 1(PD) for personal injury or occupational disease as set out in the Fourth Schedule.
(2) The application form, together with the documents prescribed in regulation 36 of the National Social Security Fund (General) Regulations * shall be delivered to the nearest office of the Fund.
(3) The claim for employment injury benefit shall comply with the provisions of the National Social Security Fund (General) Regulations, 1998 regarding time limits for claiming and submission of necessary supporting documents.
5. Conditions for award of benefits
(1) An insured person who has sustained an employment injury or occupational disease whilst in insurable employment shall be entitled to benefits under these Regulations.
(2) Every insured person claiming temporary incapacity benefits shall furnish evidence of temporary incapacity in respect of his days of temporary incapacity by means of a medical certificate given by an accredited medical provider in accordance with these Regulations on form MED 1:
(3) The Director-General may at his discretion request for any other evidence of temporary disablement if in his opinion the circumstances of a particular case so justify, and the additional evidence shall contain such particulars and shall be attested in such manner as may be specified by the Director-General.
(4) The medical certificate form MED 1 Part II shall be completed by the accredited medical provider to state the form of incapacity which in the opinion of the accredited medical provider renders the insured person temporarily incapable of work and gives the initial duration of the capacity so incurred.
(5) Where an insured person states that the temporary disablement started from a date earlier than the date of medical examination, the accredited medical provider may, if he is satisfied with the date of commencement of incapacity, so certify temporary disablement from such earlier date, and that date shall not ordinarily be earlier than seven days immediately prior to the examination.
(6) An insured person who has sustained personal injury of a minor nature shall not be entitled to any benefit under these Regulations.
(7) The accredited medical provider's cost for assessing the state and extent of incapacity in relation to an injured insured person shall be paid by the Fund and the medical certificate shall be provided free of charge to the insured person for the purpose of his claim for the benefit.
6. Notification of entitlement to benefit
An insured person who claims for benefit under these Regulations shall be notified of his entitlement to the benefit or rejection of his claim by forms EIB 14 or EIB 15 as set out in the Fourth Schedule.
7. Benefits
Employment injury or occupational disease benefit shall comprise of–
(a) cash benefit for temporary or permanent disablement;
(b) death benefit; or
(c) artificial limb.
8. Cash benefit
(1) An insured person is entitled to cash benefit in the case of temporary disablement benefit, at the rate of fifty per centum of the average daily insurable earnings calculated by reference to the earnings received during the six months of insurable employment immediately prior to the month in which the accident occurred for a maximum period of twenty-six weeks commencing from the date of the accident or date of development of the disease.
(2) An insured person who is eligible for temporary disablement benefit shall not be entitled to receive the benefit for the first three days of any continuous period of incapacity for work resulting from the injury, but only as from the fourth day of that period.
(3) For purpose of computing the first three days of any continuous period of incapacity for work mentioned in subregulation (2)–
(a) public holiday and Sundays shall be included;
(b) the commencement of the calculation of the period of three days shall begin from the day on which the insured person sustained the employment injury whether or not he was paid wages in respect of that day.
(4) In the case of permanent disablement benefit the benefit shall be calculated by reference to the appropriate proportion of the one hundred per centum rate of disablement to which the beneficiary is entitled and the one hundred per centum shall be sixty per centum of the insured person's average monthly insurable earnings which shall be paid monthly throughout the period of the disability.
(5) An insured person shall be entitled to permanent disablement benefit if he suffers as the result of the relevant accident from loss of physical or mental faculty such that the extent of the resulting disablement assessed in accordance with regulation 14 amounts to not less than one per centum.
(6) Where the extent of the permanent disablement is assessed for the period taken into account as amounting to less than thirty per centum, permanent disablement benefit shall be paid in the form of a lumpsum and the amount payable shall–
(a) if the period taken into account by the assessment is limited by reference to the beneficiary's life or is not less than seven years, be a lumpsum equal to eighty-four times the amount which bears to the monthly amount of the permanent total disablement benefit the same ratio as the percentage loss of faculty, as assessed, bears to one hundred percent; or
(b) in any other case be a lumpsum equal to the number of months for which the assessment has been given times the amount which bears to the monthly amount of the permanent total disablement benefit the same ratio as the per centum loss of faculty is assessed bear to any one hundred per centum.
(7) Where the extent of the permanent disablement is assessed for the period taken into account amounting to thirty per centum or more, the permanent disablement benefit shall be paid in the form of a pension for that period, payable monthly in arrears, and shall be that portion of the permanent total disablement benefit which the percentage assessed bears one hundred per centum.
(8) Where a period is limited by reference to a definite date, the pension shall cease on the death of the beneficiary if it occurs before that date:
Provided further that where the period is for life the pension shall be paid for a maximum of seven years.
(9) In the case of permanent total disablement, and where the Medical Board is satisfied that the insured person is in need of the constant attendance of another person, the rate of pension shall be increased by twenty-five per centum.
(10) The rate of permanent disablement benefit shall be determined in accordance with the Second Schedule to these Regulations.
(11) Where a person suffers two or more successive accidents, against which he is insured under the Act, he shall not for the same period be entitled to receive temporary disablement benefit and permanent disablement benefit, but shall be intitled to receive the benefit which is payable at a higher rate.
(12) Where a medical practitioner grants a certificate–
(a) that an insured person is suffering from an occupational disease causing disablement or that the death of an insured person was caused by an occupational disease; and
(b) that such disease was due to the nature of the insured person's employment,
the insured person, if he is deceased, his survivors shall be entitled to claim benefits under these Regulations as if the disablement or death had been caused by an employment injury.
9. Artificial limbs
(1) Artificial limbs shall be provided to an insured person who sustains injury in the course of his employment and upon certification of the Medical Board that the injured person requires to be provided with the artificial limbs.
(2) In the case of provision of artificial limbs the Fund shall provide those limbs which are available in specified public hospitals within the country.
(3) The artificial limbs provided to an insured person may be replaced on recommendation by the Medical Board.
10. Death benefit
(1) Where an insured person dies as a result of an employment injury before a claim to employment injury benefit could be made, the disability will be assumed to have been hundred per centum and the survivors will be paid a pension equal to sixty per centum of the deceased insured person average monthly insurable earnings.
(2) Where an insured person dies as a result of an employment injury during the period in which employment injury benefit is in payment, the survivors shall be paid a lumpsum equal to the insured person's monthly benefit multiplied by twelve.
(3) Where the survivors entitled to death benefit under subregulation (1) and (2) are also eligible to another survivors benefit under the Act at the same time they shall be entitled to receive the benefit which is payable at a higher rate.
(4) A claim to death benefit shall be submitted to the Board on Form EIB 13 by the survivors concerned or by their legal representative or in case of a minor, by the guardian or where there is no guardian, by any other person as the Board may deem fit.
(5) The claim for death benefit shall comply with the provisions of the National Social Security Fund (General) Regulations *, regarding time limits for claiming and submission of necessary supporting documents.
(6) Death benefit pension payment shall cease to be paid at the expiration of seven years from the date of accident or marriage of a surviving spouse or death or attainment of eighteen years whichever comes earlier.
11. Negligence by an insured person
In any case where an accident results from the negligence of an insured person, the Fund shall not be liable to provide any of the employment injury benefits to that person.
12. Time limits for claims to employment injury
All applications for employment injury benefit shall be made within a prescribed period, as follows–
(a) benefit for temporary disablement benefit within a period of twelve weeks, commencing with the date of the accident;
(b) permanent disablement benefit within a period of twelve weeks commencing with the first day for which the benefit is claimed:
Provided that the Director-General may, where there is a good cause for delay, consider any claim received after expiration of the limitation period.
PART III
MEDICAL BOARD AND MEDICAL APPEALS TRIBUNAL (regs 13-20)
13. Composition and responsibility of the Medical Board
(1) The Medical Board shall consist of a chairman and two members, all of whom shall be experienced medical practitioners.
(2) A Medical Board shall be constituted when there is an issue requiring determination and such Medical Board shall sit at such a place as the matter to be determined may require.
(3) It shall be the duty of the Director-General to inform the Medical Board of the need for a medical examination and that Medical Board shall be responsible for determining–
(a) the degree of disability as specified in the Second Schedule to these Regulations;
(b) whether the relevant loss of faculty resulted from the relevant accident;
(c) the period for which the assessment is to be made;
(d) whether the assessment should be provisional or final.
(4) The Medical Board shall notify the Director-General of its findings on subregulation (3) in writing.
14. Review of decision of Medical Board
In the case of a provisional assessment, the Medical Board acting on a request from the Fund shall provide a further assessment.
15. Appeals against a decision of a Medical Board
Where either the claimant or the Director-General is aggrieved with the decision of a Medical Board, he may at not later than one month from the date on which the decision was communicated to him, lodge an appeal against such decision to the Tribunal.
16. Powers of the Medical Appeals Tribunal
The Tribunal may revise a decision of a Medical Board.
17. Decisions of Medical Appeals Tribunal
The decision of the majority of the members shall be the decision of the Tribunal and the decision shall be final and conclusive.
18. Procedures of Medical Appeals Tribunal
(1) An Appeal shall be made on an approved form and shall contain a statement of the grounds upon which the appeal is based.
(2) The Tribunal may, on application made to that effect and on good cause shown to its satisfaction, extend the time within which an appeal may be lodged.
(3) The appellant shall be entitled to be heard by the Tribunal in person, if the appellant is the Director-General he may be represented by an authorized officer.
(4) Where any member of the Tribunal other than the chairman is absent and the appellant agrees to the matter being proceeded with, notwithstanding the absence, the Tribunal as constituted may hear and determine the matter in issue.
(5) The decision of the Tribunal shall be given in writing and shall include a statement of the facts on which the decision is based.
(6) The decision of the Tribunal shall be communicated in writing to any party to the proceedings and to such other person who, in the opinion of the Tribunal, is an interested party.
19. Fees for lodging an appeal
Any beneficiary lodging an appeal against the decision of the Medical Board shall pay a non-refundable fee as declared by the Minister.
20. Remuneration of the Tribunal and Medical Board
A member of Tribunal and Medical Board shall be entitled to receive such remuneration as the Board may determine from time to time.
PART IV
MISCELLANEOUS PROVISIONS (regs 21-23)
21. Measures to improve the welfare of an insured person
(1) The Board may promote measures or co-operate with existing institutions for the improvement of the health, occupational safety and welfare of insured persons and for the rehabilitation and re-employment of insured persons who have been disabled and injured and may incur in respect of such measures expenditures within such limits as may be prescribed.
(2) The Board may provide support for facilities for physical or vacational rehabilitation as may be prescribed.
(3) An insured person who has to undergo physical rehabilitation or attend approved vocational rehabilitation courses or who has to be fitted with prosthetic appliances may be paid or re-imbursed travelling and other expenses reasonably incurred in connection with the measures and courses and fitting of the appliances.
22. Factory inspection
(1) Every labour inspector under the Ministry responsible for labour shall continue to be responsible for inspection of factories, officers or shops on matters concerning the health, safety or comfort of workers in line with all safety regulations.
(2) The Board shall, when considering a claim for work injury benefit, take into consideration, certified reports made by labour inspectors in relation to the factory, office or shop where the claimant was employed at the time of injury.
(3) In case an accident occurs due to the failure of the employer to undertake reasonable measures in safeguarding the working condition, the Fund shall not be liable to provide employment injury benefits to any of his employees and if the same is provided the Fund shall claim from the employer all costs incurred under these Regulations.
23. Liability under Workmen's Compensation Act
Except for the provisions of regulation 22(3) employers registered with the Fund and paying contributions for their insured person shall not be liable to pay workman's compensation to their employees.
FIRST SCHEDULE
1. For the purpose of regulation 2 the expression "average daily earnings" means–
(a) where the insured person has been employed for a period of six months immediately preceding the month in which the injury occurred, the sum of the earnings on which contributions were based over that period divided by 180;
(b) where the insured person has been employed for a period of less than six months immediately preceding the month in which the injury occurred, the sum of the insurable earnings over that period of complete months, divided by the total number of days in that period;
(c) where the insured person has been employed for a period of more than one year immediately preceding the month in which the injury occurred the sum of 12 months contributions, divided by 12; or
(d) where the insured person has been employed for a period of less than one year immediately preceding the month in which the injury occurred, the sum of insurable earnings over the period of complete months, divided by the total number of months in that period.
SECOND SCHEDULE
[Rates omitted. Items for which compensation may be claimed are listed below.]
Loss of two limbs |
Loss of both hands or of all fingers and both thumbs |
Total loss of sight |
Total paralysis |
Injuries resulting in being bedridden permanently |
Any other injury causing permanent total disablement |
Loss of remaining eye by one eyed workman |
Loss of remaining arm by one armed workman |
Loss of remaining leg by one legged workman |
Loss of arm at shoulder |
Loss of arm between elbow and shoulder |
Loss of arm at elbow |
Loss of arm between wrist and elbow |
Loss of hand at wrist |
Loss of four fingers and thumb of one hand |
Loss of four fingers |
Loss of thumb |
both phalanges |
one phalanx |
Loss of index finger |
three phalanges |
two phalanges |
one phalanx |
Loss of middle finger |
three phalanges |
two phalanges |
one phalanx |
Loss of ring finger |
three phalanges |
two phalanges |
one phalanx |
Loss of little finger |
three phalanges |
two phalanges |
one phalanx |
Loss of metacarpals |
first or second (additional) |
third, fourth or fifth (additional) |
Loss of leg at or above knee |
Loss of leg below knee |
Loss of foot |
Loss of toes |
all |
great, both phalanx |
great, one phalanx |
other than great, if more than one toe lost |
Loss of eye |
eye out |
sight of |
lens of |
sight of, except perception of light |
Loss of hearing |
Both ears |
one ear |
Total permanent loss of use of member shall be treated as loss of member. |
The percentage of incapacity for ankylosis of any joint shall be reckoned as from 25 to 100 per centum of the incapacity for loss of the part at the joint, according to whether the joint is ankylosed in a favourable or unfavourable position.
In the case of a right handed workman, an injury to the left arm or hand and in the case of a left handed workman, to the right arm or hand shall be rated at ninety per centum of the above percentages.
Where there is a loss of two or more parts of the hand, the percentage of incapacity shall not be more that for the whole hand.
Where there are two or more injuries, the sum of the percentages for such injuries may be increased, and, where such injuries are to the hand the following basis of computing the increased shall be adopted, namely–
(a) where two digits have been injured, the sum total of the percentages shall be increased by forty per centum of such total;
(b) where three digits have been injured, the sum total of the percentages shall be increased by thirty per centum of such sum total;
(c) where four digits have been injured, the sum total of the percentages shall be increased by twenty per centum of such sum total.
A one-eyed workman who on entering employment has failed to disclose the fact that he is one eyed to his employer shall, if he loses his remaining eye, be entitled to compensation in respect of a degree of disablement of thirty per centum only.
For the purposes of this Schedule, a one-eyed workman means a workman who has lost the sight of one eye.
THIRD SCHEDULE
OCCUPATIONAL DISEASES
Any occupation involving: |
|
Anthrax | Work in connection with animals or the handling of animal carcasses or parts of such carcasses or of wool, hair, bristles, hides, skins, hoofs or horns. |
Chrome ulceration or its sequelae | The use or handling of chromic acid chromate or bichromate of ammonium, potassium, sodium or zinc, or any preparation or solution containing any of these substances. |
Compressed air illness or its sequelae | Subjection to compressed air. |
Inflammation or ulceration of the skin produced by dust, liquid or vapour (excluding chrome ulceration or its sequelae). | Exposure to the action of radium radio-active substances or X-rays. |
Pathological manifestations due to– | Exposure to the action of radium radio-active substances or X-rays. |
(a) radium or other radio-active substance; | |
(b) X-rays. | |
Primary epitheliomatous cancer or ulceration of the skin | The use or handling of, or exposure to, tar, pitch, bitumen, mineral oil compound, product, or residue of any of these substances. |
Subcutaneous cellulitis of the hand (beat hand) | Manual labour causing severe or prolonged friction or pressure on the hand. |
Subcutaneous or acute bursitis arising at or about the knee (beat knee) | Manual labour causing severe or prolonged friction or pressure at or about the knee. |
Telegraphist's cramp | The use of Morse-key telegraphic instruments for prolonged periods. |
Poisoning by– | |
Arsenic or the sequelae thereof | The use or handling of, or exposure to the fumes, dust, or vapour of, arsenic or a compound of arsenic or a substance containing arsenic. |
Benzene or a homologue, and the sequelae thereof: A nitro or amino derivative of benzene or of a homologue of benzene, and the sequelae thereof | The use or handling of, or exposure to the fumes of, or vapour containing benzene or any of its homologues or a nitro or amino derivative of benzene or of a homologue of benzene. |
Cyanide, or the sequelae hereof (including cyanide rash) | The use or handling of, or exposure to the fumes of, or dust or vapour containing any cyanide or a substance containing cyanide. |
Dinitrophenols or their salts; dinitrosubstituted phenols or their salts | The use or handling of, or exposure to the fumes of, or vapour containing any dinitrophenol or its salt or any dinitro-substituted phenol or its salt. |
Halogen derivatives of hydrocarbons of the aliphatic series | The use or handling of, or exposure to the fumes of, or vapour containing any halogen derivative of any hydrocarbon of the aliphatic series. |
Lead, or the sequelae thereof | The use or handling of, or exposure to the fumes, dust or vapour of, lead or a compound of lead, or a substance containing lead. |
Organophosphorus compounds | The use or handling of, or exposure to the fumes of, or vapour containing any of the organophosphorus compounds. |
FOURTH SCHEDULE
FORMS
FORM EIB. 1(A)
CLAIM FOR EMPLOYMENT INJURY BENEFIT IN RESPECT OF AN INDUSTRIAL ACCIDENT
NSSF LOGO | |||||||
NATIONAL SOCIAL SECURITY FUND |
|||||||
IMPORTANT: |
|||||||
You should complete this claim form and return it directly to your nearest NSSF office as soon as possible. You should complete the medical certificate, form Med 1 (Part 1), then take it to your medical provider, who will complete Part 2. It should then be given to your employer who will note its contents and send it directly to the NSSF office. |
|||||||
Your claim can only be processed when all those three activities have been completed. |
|||||||
Please use Capital Letters throughout. |
|||||||
Claims number |
|
||||||
Information About You |
|||||||
Your NSSF No: |
|
||||||
Registration Number |
|
||||||
Surname or family name | |||||||
All other names (Given names in full) | |||||||
All other family/surnames/maiden names which you have been | |||||||
Date of birth | |||||||
Permanent address (physical & postal) | |||||||
Nationality/Tribe | |||||||
Father's name-in full | |||||||
Mother's name-in full | |||||||
Details of your NSSF membership |
|||||||
Date of Joining NSSF | Office of Registration | ||||||
Information about your employer(s) |
|||||||
Your present employer | Name ..................................................................... |
||||||
Address ................................................................. |
|||||||
Employed from ............../ ............../ .............. |
|||||||
Previous Employer(s) - if any | Name ..................................................................... |
||||||
Employer No. 1 | Address .................................................................. |
||||||
Employed from ....................to ........................ |
|||||||
Employer No. 2 | Name ..................................................................... |
||||||
Address .................................................................. |
|||||||
Employed from ....................to ........................ |
|||||||
If you have had more than two previous employers, please attach the details to this form. |
|||||||
Details of previous claims which you have made to NSSF |
|||||||
Have you applied for any other benefits in the past? YES............... /NO ............... |
|||||||
IF YES, give the following details |
|||||||
Type of Benefit | Office and date at which Claim was made | Period for which it was paid | Amount of Benefit Paid |
||||
Please give the following Information about your occupation and the accident which you had |
|||||||
What was your occupation/job at the time the accident happened? ..................................... |
|||||||
Describe the injury which you suffered? ............................................................................ |
|||||||
..................................................................................................................................... |
|||||||
When did the accident happen | |||||||
How did the accident happen? (State briefly, in your own words, the circumstances of the accident, and what you were doing at that time) .................................................................... |
|||||||
.......................................................................................................................................... |
|||||||
Give the names of any two witnesses to the accident. |
|||||||
1 Full Name ..................................... | 2. Full Name .............................................. |
||||||
Postal Address .............................. | Postal Address ...................................... |
||||||
Physical Address .......................... | Physical Address ................................... |
||||||
If you have had more than two witnesses, please attach the details to this form. When was the accident first reported to your employer? ................................................... |
|||||||
......................................................................................................................................... |
|||||||
To whom did you report? ................................................................................................. |
|||||||
Did you visit a Hospital/Clinic/Dispensary after your accident? YES ............ / NO............. |
|||||||
If YES: Please give the following details. |
|||||||
|
|||||||
Postal Address ......................................................................................................... |
|||||||
Physical Address ...................................................................................................... |
|||||||
Date ................................ and time ............................... am/pm of your visit |
|||||||
If you know the name(s) of the Doctor(s) who attended you please mention them here: |
|||||||
Name ................................................ Registration number ....................................... |
|||||||
Name ................................................ Registration number ....................................... |
|||||||
|
|||||||
The following documents must be submitted to NSSF with this claim form - please tick in the boxes to show which of them you have attached to this Claim form. |
|||||||
Your original NSSF membership card (NSSF 4) three Passport size photos A Medical Certificate (Form Med. 1) |
|||||||
Arrangements for Payment of Your Benefit |
|||||||
If Temporary Disablement Benefit becomes payable, you will be required to provide medical evidence, which confirms that you are incapable of work. Payments will usually be at monthly intervals. NSSF will pay payments in respect of temporary disablement benefit from the 3rd day of incapacity to a maximum of 26 weeks. For that reason we will need to know how you wish NSSF to pay you. Please therefore complete one of the following options to show how you wish to receive payment(s). |
|||||||
(i) The benefit cheque should be sent to my bank | Name of bank ............................................. |
||||||
Address ...................................................... |
|||||||
Town .......................................................... |
|||||||
Account Number ......................................... |
|||||||
(ii) I wish to collect the cheque at the NSSF Office at | |||||||
Declaration | |||||||
I declare that, the statements, which I have given in this form are true to the best of my knowledge and belief. I understand that, by making a claim to any of the social insurance benefits (maternity, employment injury and health) which are paid under the new NSSF Act, I am bound by all the conditions which apply under the Act. |
|||||||
Thumb print |
|||||||
Signature of claimant ..................................... Date .............................. |
|||||||
Attesting witness 1 .......................................... Date .............................. |
|||||||
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person, to which they are not entitled, makes a false statement or produces or furnishes- or causes to be produced or furnished- any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 1(PD)
CLAIM FOR EMPLOYMENT INJURY BENEFIT IN RESPECT OF AN INDUSTRIALPRESCRIBED DISEASE
NSSF LOGO | ||||||
NATIONAL SOCIAL SECURITY FUND |
||||||
IMPORTANT: |
||||||
You should complete this claim form and return it directly to your nearest NSSF office as soon as possible. You should complete the medical certificate-Form Med 1 (Part 1) - then take it to your medical provider, who will complete Part 2. It should then be given to your employer who will note its contents and send it directly to the NSSF office. |
||||||
Your claim will be processed when all forms ie EIB 1 (PD), EIB 2 (PD) and Med 1 have been completed and submitted to the Fund. |
||||||
Please use Capital Letters throughout. |
||||||
Claims number |
|
|||||
Information About You |
||||||
Your NSSF Number |
|
|||||
Surname or family name | ||||||
All other names which you have been known by (Given names in full) | ||||||
Date of birth | ||||||
Permanent address (physical & postal) | ||||||
Nationality/Tribe | ||||||
Place of birth (Region/District/Village) | ||||||
Father's name - in full | ||||||
Mother's name - in full | ||||||
Details of Your NSSF Membership |
||||||
Date of Joining | Office of Registration | |||||
NSSF | (where you were registered first) |
|||||
Information about your employer(s) |
||||||
Your Current employer | Name ........................................................................... |
|||||
Address ........................................................................ |
||||||
Employed from ............................... to ........................... |
||||||
Previous Employer(s) -if any | Name ........................................................................... |
|||||
Employer No. 1 | Address ........................................................................ |
|||||
Employed from ............................... to ........................... |
||||||
Employer No. 2 | Name ........................................................................... |
|||||
Address ........................................................................ |
||||||
Employed from ............................... to ........................... |
||||||
Employer No. 3 | Name ........................................................................... |
|||||
Address ........................................................................ |
||||||
Employed from ............................... to ........................... |
||||||
If you have had more than 3 previous employers, please attach the details to this form. |
||||||
Details of previous claims made to NSSF |
||||||
Have you applied for any other benefits in the past? (Tick where appropriate) YES ................ / NO ............................ If YES, give the following details: |
||||||
Type of Benefit | NSSF Office and date of the Claim | Period covered | Amount of Benefit paid |
|||
|
||||||
What is your present occupation/job? ............................................................................... |
||||||
...................................................................................................................................... |
||||||
Which disease do you think you have? .............................................................................. |
||||||
....................................................................................................................................... |
||||||
What type of work do you think caused the disease? .......................................................... |
||||||
....................................................................................................................................... |
||||||
How long have you been doing this type of work? ................................................................ |
||||||
What was the date on which you first started to suffer from the disease? |
||||||
Day ....................... Month ............................ Year ............................... |
||||||
Does the disease affect your work? YES ............................ /NO ............................ |
||||||
If yes, how? ............................................................................................................... |
||||||
................................................................................................................................. |
||||||
.................................................................................................................................. |
||||||
Information about previous medical treatment |
||||||
Have you ever visited a hospital/clinic/health centre/dispensary, etc., for treatment? |
||||||
if YES - Please give these details: ........................................................................................ |
||||||
......................................................................................................................................... |
||||||
Give name(s) and address(es) of any doctors(s) who have attended you for the disease and the approximate date(s) of the treatment(s): |
||||||
1. Doctor's name ................................... | Registration No: (if known) ............................ |
|||||
Address ............................................ | Date(s) of treatment(s) .................................. |
|||||
2. Doctor's name | Registration No: (if known) |
|||||
Address ................................................. | Date(s) of treatment(s) .................................. |
|||||
Notice to your employer about the disease |
||||||
Have you reported to your employer about the disease you have? YES ............. /NO ............ |
||||||
If YES - Please give the details: ........................................................................................ ....................................................................................................................................... |
||||||
Name of the person to whom you reported ........................................................................... |
||||||
His/her post/title/designation ............................................................................................... |
||||||
When did you report it? Day ........................ Month ........................ Year .......................... |
||||||
Any additional information ........................ .......................................................................... |
||||||
.......................................................................................................................................... |
||||||
Documents needed to support this claim |
||||||
The following documents must be submitted to NSSF office with this claim form (please tick which of them you have attached to this claim form). |
||||||
Your orginal NSSF membership card (NSSF/R4) Three passport-size photos A Medical Certificate (Form Med. 1) |
||||||
Arrangements for payment of your benefit |
||||||
If Temporary Disablement Benefit becomes payable, you will be required to provide medical evidence, which confirms that you are incapable of work. Payments will usually be at monthly intervals. NSSF will pay payments in respect of temporary disablement benefit from the 3rd day of incapacity to a maximum of 26 weeks. For that reason, we will need to know how you wish NSSF to pay you. Please therefore complete one of the following options to show how you wish to receive payment(s). |
||||||
(i) The benefit cheque should be sent to my bank | Name of bank .............................................. |
|||||
Address ...................................................... |
||||||
Town .......................................................... |
||||||
Account Number ......................................... |
||||||
(ii) I wish to collect the cheque at the NSSF Office at | ||||||
Declaration |
||||||
I declare that the statements, which I have given in this form are true to the best of my knowledge and belief. I understand that, by making a claim to any of the social insurance benefits (maternity, employment injury and health) which are paid under the NSSF Act, I am bound by all the conditions which apply under the Act. |
||||||
Signature of claimant ................................ Date ...................... | Right/Left |
|||||
Signature of attesting witness 1 .............................. Date ................. |
||||||
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person to which they are not entitled, makes a false statement or produces of furnishes - or causes to be produced or furnished - any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 2(A)
INQUIRY FROM AN EMPLOYER ABOUT AN INDUSTRIAL ACCIDENT
NSSF LOGO | |||
NATIONAL SOCIAL SECURITY FUND |
|||
Notes for the employer |
|||
1. The person named at Part A of this form has told us that he/she has an accident at work, as a result of which a claim under the Employment Injury Benefit has been made. |
|||
2. The NSSF requires information from you about the accident and your answers to the following questions will help us to decide whether or not there was an industrial accident and, if so, whether it can be accepted as an employment injury according to the NSSF Act and Regulations. |
|||
3. The information provide will be used only by the NSSF, but if the person named on this form appeals against the NSSF decision, it will be necessary to let him/her know what information you have provided. |
|||
4. If you need any information or assistance with these forms, please do not hesitate to contact the NSSF office. |
|||
5. Please return this form to the NSSF Office urgently (within the period of 14 days from the date of its delivery). The employee's claim cannot be decided until you return this form. |
|||
6. The employee has been asked to let you have sight of each Medical Certificate which s/he obtains in support of his/her claim(s). Please do forward them to the NSSF office immediately after you have noted or photocopied the contents. |
Part A. Details of the employee who claims to have had an accident at place of work |
|||
(To be filled in by the NSSF office after inquiring of the employee or insured person.) |
|||
Name ................................................... NSSF Registration No: -- |
|||
Address ................................................... | |||
.................................................... |
|||
.................................................... Date of Birth |
|||
Employee's Work/Check Number .................................. Job/ Occupation ............................. |
|||
.......................................................................................................................................... |
|||
Date of Accident | Place |
||
Time ............................. am/pm |
|||
Details of the injury or incapacity, which it caused: ................................................................ |
|||
.......................................................................................................................................... |
Part B. Employer information about the accident |
||
Please complete this part of the form. |
||
Have you learned of any information about the accident? ................................................... |
||
Was the accident reported to you or any authorized officer? YES NO |
||
If YES, to whom was it reported? ..................................................................................... |
||
On what date was it reported? | ||
What types of injuries were reported? (Please describe the injuries in as much detail as possible) |
||
.......................................................................................................................................... |
||
.......................................................................................................................................... |
||
Was this person working for you, in the job shown at Part A, on the date of the accident? |
||
YES | NO |
|
If NO - please explain ..................................................................................................... |
||
..................................................................................................................................... |
||
Are you satisfied that the information given at Part A, is correct? YES NO |
||
If NO - please explain ..................................................................................................... |
||
..................................................................................................................................... |
||
What type of industry/business was the person working on the day of the accident? (e.g. mining, construction, textiles, agriculture, etc.)....................................................................... |
||
.......................................................................................................................................... |
||
At the time of the accident, what were the terms of his/her employment? |
||
a sub-contractor | a trainee |
|
Any other (please specify) .................................................................................................. |
||
What hours was the person expected to work on the day of the accident? |
||
From ................................................... am/pm to ................................................... am/pm. |
||
From ................................................... am/pm to ................................................... am/pm. |
||
Give details for example if the person fell or if something fell onto him/her or them. Please indicate the height of the fall) ............................................................................................ |
||
....................................................................................................................................... |
||
At the time of the accident was the employee authorized to be where s/he was for the purposes of her/his work? YES NO |
||
Please explain ................................................................................................................ |
||
....................................................................................................................................... |
||
....................................................................................................................................... |
||
Were there any witnesses to the accident? | YES | NO |
If YES - please give name(s) and address(es) |
||
Name ........................................................ | Name ........................................................ |
|
Address ..................................................... | Address ..................................................... |
|
.................................................................. | .................................................................. |
|
Apart from the above witnesses did anyone in your company see the injuries, which were sustained? |
||
YES | NO |
|
If YES please give name(s) and address(es) |
||
Name ........................................................ | Name ........................................................ |
|
Address ..................................................... | Address ..................................................... |
|
.................................................................. | .................................................................. |
|
DECLARATION |
||
I declare that the statements which I have given in this form are true to the best of my knowledge and belief. |
||
Name (in CAPITALS) ................................. Your signature ...................... Date ................... |
||
Your position/designation in the firm ..................................................................................... |
||
Phone No. .............................. Fax No. ......................... 1 |
||
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person, to which they are not entitled, makes a false statement or produces or furnishes- or causes to be produced or furnished- any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 2(PD)
INQUIRY FROM AN EMPLOYER ABOUT AN INDUSTRIAL PRESCRIBED DISEASE
NSSF LOGO | ||
NATIONAL SOCIAL SECURITY FUND |
||
Notes for the employer |
||
1. The person named at Part A of this form has told us that he/she has an industrial prescribed disease, as a result of which a claim under the Employment Injury Benefit has been made. |
||
2. The NSSF requires information from you about the employees occupation and your answers to the following questions will help us to decide whether or not s/he is entitled to employment injury according to the NSSF Act and Regulations. |
||
3. The information provided will be used only by the NSSF, but if the person named on this form appeals against the NSSF decision, it will be necessary to let him/her know what information you have provided. |
||
4. If you need any information or assistance about these forms, please do not hesitate to contact the NSSF office. |
||
5. Please return this form to the NSSF Office urgently (within the period of 14 days from the date of its delivery). The employee's claim cannot be decided until you return this form. |
||
6. The employee has been asked to let you have sight of each Medical Certificate which s/he obtains in support of his/her claim(s). Please do forward them to the NSSF office immediately after you have noted or photocopied the contents. |
Part A. Details of the Employee Who Claims to Have an Industrial Prescribed Disease |
|
(To be filled by the NSSF office after inquiring of the employee or insured person.) |
|
Name ..................................................... NSSF Registration No: -- |
|
Address ...................................................... Date of Birth | |
Employee's Work/Check Number ................................ Job/ Occupation ............................... |
|
Details of the occupational disease which he/she has ........................................................... |
|
......................................................................................................................................... |
|
......................................................................................................................................... |
|
Date of development of disease |
PART B. Employer's Information about the employee's work |
|
Please describe the employee's work ................................................................................ |
|
.......................................................................................................................................... |
|
Have you learned of any information about the development of the employee's occupational disease? |
|
.......................................................................................................................................... |
|
.......................................................................................................................................... |
|
Was the occupational disease reported to you or any authorized office? YES NO |
|
If YES - to whom was it reported? ........................................................................................ |
|
On what date was it reported? | |
What types of occupational diseases were reported? Please give details of what was reported: for example what information you were given at the time of the report, how the disease was affecting the employee in his/her work, etc.) ..................................................... |
|
.......................................................................................................................................... |
|
.......................................................................................................................................... |
|
Was this person working for you, in the job shown at Part A, on or about the date when the disease developed? YES NO |
|
If NO - please explain ...................................................................................................... |
|
...................................................................................................................................... |
|
In which type of industry/business was the employee working? (E.g. construction, mining, textiles, agriculture, etc.) ................................................................................................. |
|
...................................................................................................................................... |
|
Has the person continued to do the same type of work since that time? YES NO |
|
If NO - please explain ..................................................................................................... |
|
..................................................................................................................................... |
|
At the time the disease is said to have developed, was the employee working on any of following terms? |
|
(Please tick which is appropriate). |
|
a company director | a business partner |
a sub-contractor | on training |
Any other (please specify) ................................................................................................... |
|
.......................................................................................................................................... |
|
Was the employee authorised to do the type of work, which is said to be responsible for the development of the disease? YES NO |
|
If NO - please explain ..................................................................................................... |
|
..................................................................................................................................... |
|
Do you know if there were any other employees who knew that the employee had developed the disease? YES NO |
|
If YES - please give name(s) and address(es) |
|
Name ......................................................... | Name ......................................................... |
Address ..................................................... | Address ..................................................... |
.................................................................. | .................................................................. |
Declaration |
|
I declare that the statements which I have given in this form are true to the best of my knowledge and belief. |
|
Name (in CAPITALS) ........................... Your signature .......................... Date ..................... |
|
Your position/designation in the firm ..................................................................................... |
|
Phone No. .............................. Fax No. .......................... 1 |
|
Official Stamp |
|
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person, to which they are not entitled, makes a false statement or produces or furnishes- or causes to be produced or furnished- any document or information which s/he knows to be false in a material particular is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 3
CALCULATION OF TEMPORARY DISABLEMENT BENEFIT
NSSF LOGO | ||||
NATIONAL SOCIAL SECURITY FUND |
||||
For Official Use Only |
||||
NSSF Registration Number | -- |
|||
Claim number |
|
|||
1. Date of accident/Date of development of disease | ||||
2. TDB Payment Period (i) From (3 days after D/A - D/D) | ||||
(ii) To (26 weeks from D/A - D/D) | ||||
3. Calculation of TDB rate |
||||
(a) Month containing D/A - D/D = |
||||
(b) Previous 6 months: | Month | Insurable earnings |
||
1. _____________ | _________________________ |
|||
2. _____________ | _________________________ |
|||
3. _____________ | _________________________ |
|||
4. _____________ | _________________________ |
|||
5. _____________ | _________________________ |
|||
6. _____________ | _________________________ |
|||
(c) Total insurable earnings: |
||||
(d) Total at 3(c) ÷ 180 |
||||
(Daily Average Insurable Earnings) = |
|
|||
4. Daily Rate ie 50% of (d) above |
|
|||
Prepared by: Name .................................................. | Designation ............................. |
|||
Signature ............................................. | Date ........................................ |
|||
Checked by: Name .................................................. | Designation .............................. |
|||
Signature ............................................. | Date ........................................ |
FORM EIB. 4
EMPLOYER'S NOTICE OF THE AWARD OF TEMPORARY DISABLEMENT BENEFIT
NSSF LOGO | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ...................................................................... | NSSF ..................................... |
|
......................................................... | ............................................... |
|
.............................................. | Phone: .................................... |
|
(Name & address of employer) | Fax: ........................................ |
|
Ref No.: NSSF/ .............................................. |
||
You will be aware that a claim to an Employment Injury Benefit was made recently by your employee namely ....................................................... whose NSSF registration number is -- under claim number |
||
This is to inform you that the above named person has been awarded temporary disablement benefit (TDB) provided under section ......................... of the NSSF Act. This benefit is payable to a maximum of 26 weeks, commencing three days from the date of accident or onset/development of disease. However, it should be noted that TDB can only be paid for days on which the employee provides medical evidence (Complete MED 1 form) which certifies that s/he is unfit for and incapable of work as a result of the same accident/disease. |
||
Details of the TDB are follows- |
||
1. The date of accident/development of the occupational disease has been accepted as- | ||
2. TDB has been awarded from- | ||
3. TDB will end on (at the end of 26 weeks) | ||
4. The TDB daily rate has been determined to be | ||
Name .................................................................. | Designation ............................. |
|
Signature ............................................................. | Date ........................................ |
FORM EIB. 5
INSURED PERSON'S NOTICE OF AN AWARD FOR TEMPORARY DISABLEMENT BENEFIT
NSSF LOGO | |||
NATIONAL SOCIAL SECURITY FUND |
|||
To: ........................................................................... | |||
............................................................................ | |||
NSSF Registration Number | |||
You recently made a claim for an Employment Injury Benefit in respect of the employment injury/occupational disease which you sustained/contracted on |
|||
I am glad to inform you that a decision has been made to award you Temporary Disablement Benefit (TDB) as detailed in the attached EIB 3 form. |
|||
Temporary Disablement Benefit (TDB) is payable for a maximum period of 26 weeks, commencing three days from the date of accident/development of disease. However payment is made only for days when you provide medical evidence confirming that you are unfit for and incapable of work because of the relevant accident/disease. |
|||
If you are still incapable of work on/after the 19th week since the date of accident/disease we will write to you again because you may need to be considered for Permanent Disablement Benefit (PDB). |
|||
You have a right to appeal against this decision and if you need more information - either about the decision or your appeal rights - please contact your nearest NSSF office. |
|||
Name ................................................................... Designation ....................................... |
|||
Signature .............................................................. Date ................................................. |
FORM EIB. 6
NOTICE OF DISALLOWANCE FOR TEMPORARY DISABLEMENT BENEFIT
NSSF LOGO | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ...................................................................... | ||
.......................................................................... | ||
NSSF Registration Number |
|
|
We regret to inform you that your recent claim No: | ||
dated ...................................................... for Employment Injury Benefit has been disallowed. |
||
The reason for that decision is that: |
||
The accident which you claim to have had was not an industrial accident as defined in the NSSF ACT. |
||
Although it is accepted that you had an accident, you were not in an insurable employment at the time of the accident. |
||
Although it is accepted that there was an accident it cannot be accepted that it arose out of and in the course of your insurable employment. |
||
Although it is accepted that there was an industrial accident, it is not accepted that your present incapacity is a result of that injury. |
||
The disease from which you claim to be suffering is not included in the list of prescribed occupational diseases in the legislation. |
||
Although it is accepted that you do have an occupational disease, it is not accepted that your incapacity is a direct result of that disease. |
||
Others ............................................................................................................... |
||
A copy of this notice has been sent to your employer for information. |
||
You have a right to appeal against this decision to the Medical Appeals Tribunal and if you need more information please contact your nearest NSSF office. |
||
Name: .......................................................... | Designation: ..................................... |
|
Signature: ..................................................... | Date: ................................................ |
FORM EIB. 7
CLAIM FOR PERMANENT DISABLEMENT BENEFIT
NSSF LOGO | ||
NATIONAL SOCIAL SECURITY FUND |
||
IMPORTANT |
||
Please read the contents of these notes carefully before completing this form. |
||
Have you made a claim for Employment Injury Benefit (Temporary Disablement Benefit) in respect of the accident or occupational disease which is now the subject of this claim? |
||
If Yes read Part A | If No read Part B |
|
Part A | ||
At the time when you made that claim you should have completed either NSSF form EIB. 1(A) or NSSF form EIB. 1(PD). The form asked for full details of your work, the circumstances of the accident or what had caused the disease, etc. |
||
If you are certain that you did complete one of those forms, you only need to complete part C of this form in order to make your claim for Permanent Disablement Benefit. |
||
Part B |
||
If you have not previously made any claim in respect of your employment injury or occupational disease you will need to obtain one of the following forms from the nearest NSSF office: |
||
• NSSF EIB.1(A) form - for claims resulting from industrial accidents. |
||
• NSSF EIB.1(PD) form - for claims resulting from occupational disease (referred to as a prescribed disease). |
||
You should then complete any of the above forms and submit it to the nearest NSSF office together with this form, completed at Part C. |
||
It is also important that before submitting these forms and EIB.1(A) or EIB.2(PD) you make sure that your employer is aware of an industrial accident or prescribed disease. |
||
Part C | ||
Section 1. Information about you | ||
Your NSSF Registration Number |
|
|
Surname or family name | ||
Other names (Given names) in full | ||
All other family/surnames/maiden names by which you have been known. | ||
Date of Birth | ||
Permanent address (physical and postal) | ||
Nationality/Tribe | ||
Father's name in full | ||
Mother's name in full | ||
Section 2. Information about your disability |
||
1. Describe, in your own words, the disability which you claim to have. |
||
......................................................................................................................................... |
||
......................................................................................................................................... |
||
......................................................................................................................................... |
||
2. What do you think caused that disability? |
||
......................................................................................................................................... |
||
......................................................................................................................................... |
||
......................................................................................................................................... |
||
3. If the disability was caused by an accident at work, give the date of that accident. | ||
4. If the disability was caused by an occupational disease, give the date from which the disease was accepted to have developed. | ||
5. Have you claimed or received any other type of employment injury disablement benefit in respect of the condition described at question 1 above? |
||
Yes | No |
|
If yes, say which benefit................................................................................................ |
||
When was it claimed? | ||
6. It is important to note that before your claim can be decided, you will need to be examined by a Medical Board. |
||
Arrangements for payment of your benefit |
||
Permanent Disablement Benefit becomes payable to an insured person who sustained injury or occupational disease and is unable to work from or before the 26th week of Temporary Disablement preceding his/her accident or occupational disease. |
||
Please therefore complete one of the following options to show how you wish to receive payment(s). |
||
(i) The benefit cheque should be sent to my bank | Name of bank ............................................ |
|
Address .................................................... |
||
Town ........................................................ |
||
Account Number ....................................... |
||
(ii) I wish to collect the cheque at the NSSF office at | ||
Declaration | ||
I declare that to the best of my knowledge and belief, the statements which I have given in this form are true. I understand that by making a claim to any of the social insurance benefits which are paid under the NSSF Act, I am bound by all the conditions which apply under the Act. Signature of claimant .......................... Date ............................. |
||
Thumb print (to be filled |
||
Signature of | 2 Right / Left |
|
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person, to which they are not entitled, makes a false statement or produces or furnishes - or causes to be produced or furnished - any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 8
CALCULATION OF PERMANENT DISABLEMENT BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
NSSF Registration Number |
|
|
Claims number |
||
1. Date of relevant accident/development of disease | ||
2. Details of Medical Board assessment |
||
(a) The medical Board has determined the period of disability to be: |
||
| From to |
|
(b) The assessment of the Board is Provisional/Final (Delete as appropriate) |
||
(c) The rate of disability has been determined to be % |
||
3. PDB will be paid as (type of payment) Lump sum Monthly Pension |
||
4. Establish the 100% rate of PDB for this I/P. |
||
(a) Insurable earnings for 12 months prior to the D/A or D/D |
||
Month | Monthly Insurable earnings |
|
.......................................... | ..................................................... |
|
Total | _____________________________ T.Shs. |
|
(b) Determine the Average Monthly Insurable Earnings (AMIE) i.e. 4(a) ÷ 12 (months) |
||
(c) Determine the 100% of PDB, i.e. 4(b) x 60% = ___________ T.Shs. |
||
(d) Determine amount payable ie PDB at 100% as at 4(c) multiplied by % of disability as indicated at 2 (c): |
||
5. If the insured person is entitled to pension (i.e. where the assessment is 30% or more) the amount determined at 4(d) becomes the PDB monthly pension for the period prescribed i.e. PDB at 100% multiplied by % of disability =______________ T.Shs. |
||
6. If however the Insured person is entitled to lumpsum (i.e. where the assessment is between 1% and 29%) the amount payable is equal to amount payable [4(d)] multiplied by the number of months for which s/he will be disabled [2(a)] =_____________ T.Shs. |
||
Amount payable is T.Shs. ________________________ as per 5/6 above |
||
Prepared by: Name: ......................................... Designation: ................................ |
||
Signature: ........................................ Date: ...................................... |
||
Checked by: Name: ......................................... Designation: ................................ |
||
Signature: ........................................ Date: ...................................... |
FORM EIB. 9
EMPLOYER'S NOTICE OF AN AWARD OF PERMANENT DISABLEMENT BENEFIT
NSSF LOGO | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ..................................................... | ||
Ref. No. NSSF/ ......................................... | ||
You will be aware that a claim for permanent disablement benefit was made recently by your employee Mr./Mrs./Miss/Ms. ........................................................................................... |
||
whose NSSF registration number is _ _ under claim |
||
number |
||
This is to inform you that the above named person has been awarded permanent disablement benefit (PDB) provided under section ............................................ of the NSSF Act. He/She will be entitled to PDB for the period of ........................................................... days/months/years from (date) .................................... to .............................................. |
||
Payment of PDB will terminate payment of TDB from the effective date of PDB. If you require any further information, please contact your nearest NSSF office. |
||
Name: ..................................................... | Designation: ............................................. |
|
Signature: ................................................ | Date: ........................................................ |
FORM EIB. 10
INSURED PERSON'S NOTICE OF AN AWARD FOR PERMANENT DISABLEMENT BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ..................................................... ..................................................... | ||
NSSF Registration Number |
|
|
Claims Number |
|
|
Please refer to your recent claim to permanent disablement benefit (PDB) and the Medical Board examination, which you attended on (date) ............................................................... |
||
This is to inform you that as a result of |
||
An accident on ................................................................................................. |
||
Occupational disease, which developed on/about ................................................. |
||
you have been awarded Permanent Disablement Benefit (PDB). Payment will be based on the degree of disability, which was assessed by the Medical Board as being % |
||
The period for which PDB is payable is from .............................................to ....................... |
||
Pension at the rate of T.Shs. .......................................... per month |
||
A lump sum of T.Shs. .................................................... |
||
It is important to note that the assessment of the Medical Board was regarded as: |
||
Final, which means there will be no need for further Medical Board examinations |
||
Provisional - which means that you will be asked to attend a Medical Board before the present assessment expires |
||
Details of the way PDB has been calculated is as per attached EIB. 8 form. |
||
You have a right to appeal against this decision and if you need more information please contact your nearest NSSF office. |
||
Name: ....................................................... | Designation: .............................................. |
FORM EIB. 11
NOTICE OF DISALLOWANCE FOR PERMANENT DISABLEMENT BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ..................................................... ..................................................... | ||
NSSF Registration Number |
|
|
We regret to inform you that your recent claim No: |
|
|
dated ............................................................... for Permanent Disablement Benefit has been |
||
The reason for this decision is that: |
||
The Medical Board which examined you in connection with the claim has concluded that the relevant accident has not resulted in any loss of faculty or disability. |
||
The extent of your disability was assessed as less than 1% and the NSSF Regulations do not provide for an award for such assessments. |
||
Although the Medical Board established that there is a degree of disability, their findings were that it did not result from the relevant accident or disease. |
||
Others (if any) .................................................................................................... .......................................................................................................................... |
||
You have a right to appeal against this decision to the Medical Appeals Tribunal and if you need more information please contact your nearest NSSF office. |
||
Name: ....................................................... | Designation: ............................................... |
|
Signature: .................................................. | Date: ......................................................... |
FORM EIB. 12
CLAIM FOR EMPLOYMENT INJURY DEATH BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
This form is divided into two parts to be completed as follows: Part I: To be completed by the person claiming for death benefit; and Part II: To be completed by the Employer of the deceased person. |
||
IMPORTANT: | ||
Death Benefit can be claimed if the NSSF member (insured person) dies as a result of an accident or prescribed disease s/he had at work. On receipt of the completed form, an officer from the NSSF will arrange to interview you as soon as possible in order to clear any doubt before the claim can be processed. |
||
Please use CAPITAL LETTERS throughout. |
||
Claim number |
Part I: Information to Support the Claim |
|
(a) Information about the person claiming death benefit |
|
Name of the Claimant - in full | |
Date of birth | |
Address (in full) | |
Your relationship to the deceased | |
(b) Information about the deceased insured person |
|
Name of deceased NSSF Member (in full) | |
NSSF membership number - if known |
|
Date of Birth | |
Address (Postal) | |
Date of the employment accident which is thought to have caused the death | |
If death was the result of an occupational disease - state which disease ........................... |
|
Was the deceased person receiving any of the following benefits from NSSF before his/her death? (Tick which applies.) |
|
Temporary Disablement Benefit Permanent Disablement Benefit |
|
If the deceased was not receiving NSSF benefits at the time of death, do you know if the accident or disease was reported to his/her employer? Yes No |
|
Declaration |
|
I declare that, to the best of my knowledge and belief, the statements which I have given in this form are true. |
Part II: Employer's information about the deceased insured person |
||
Name of the Employer: .................................................................................................... |
||
NSSF Registration Number |
|
|
I hereby confirm that the deceased Mr./Mrs./Miss ................................................................ |
||
Name: ...................................................... | Designation: ............................................. |
|
Signature: ................................................. | Date: ........................................................ |
|
Warning: Any person who, for the purpose of obtaining any benefit, for herself or himself or for some other person, to which they are not entitled, makes a false statement or produces or furnishes - or causes to be produced or furnished - any document or information which s/he knows to be false in a material particular, is guilty of an offence under the National Social Security Fund Act. |
FORM EIB. 13
CALCULATION OF DEATH BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
NSSF Registration Number | _ _ |
|
Claims number |
|
|
1. Date of Accident/Date of Development of Disease | ||
2. Payment made in respect of a deceased member who was in receipt of PDB |
||
(a) Current Monthly rate of PDB = | ||
(b) Multiply 2(a) by 12 = | ||
This is paid as a lump sum. | ||
3. Payment made to a deceased member who was not receiving PDB |
||
(a) Determine the notional 100% of PDB i.e. 60% of the deceased member's average monthly insurable earnings | ||
This is paid as pension for life i.e. seven years. |
||
Prepared by: Name: .............................. | Designation: .............................................. |
|
Signature: .......................... | Date: ......................................................... |
|
Checked by: Name: ............................... | Designation: .............................................. |
|
Signature: .......................... | Date: ......................................................... |
FORM EIB. 14
NOTIFICATION OF AN AWARD OF DEATH BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ..................................................... | ||
NSSF Registration Number | _ _ |
|
Claims number |
|
|
We are sorry to learn of the death of Mr./Mrs./Miss/Ms. .................................................... |
||
In connection with your recent claim for death benefit payable under the employment injury branch, we are pleased to inform you that an award of Death Benefit has been granted. |
||
Please arrange to collect your payments cheque at the NSSF office where you lodged your claim. |
||
Name: ..................................................... | Designation: .............................................. |
|
Signature: ................................................ | Date: ........................................................ |
FORM EIB. 15
NOTICE OF DISALLOWANCE FOR DEATH BENEFIT
NSSF | ||
NATIONAL SOCIAL SECURITY FUND |
||
To: ..................................................... | ||
NSSF Registration Number |
|
|
Claims Number |
|
|
We are sorry to learn the death of Mr./Mrs./Miss/Ms. ...................................................... which took place on ........................................ and wish to offer the Fund's condolences to the family of the deceased. |
||
In connection with your recent claim for death benefit payable under the employment injury branch, we regret to inform you that the claim has been disallowed for the following reason(s): |
||
The death could not be accepted to have resulted from an employment injury. The deceased was not in insurable employment at the time of the accident. |
||
The disease, which led to the death is not prescribed in relation to the industry or occupation. |
||
Others .............................................................................................................. |
||
However, you may claim for survivor's benefits provided for under section 33 of the NSSF Act. |
||
Name: ...................................................... | Designation: .............................................. |
|
Signature: ................................................. | Date: ........................................................ |
{/mprestriction}