Form Of Claim For Senior Citizens Page 3
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18. Is any sum payable by you (if a married man separated from his wife) to your wife by way of
maintenance …………………… If so, how much?..........................................................................
19. Have you been working in Trinidad and Tobago for the last twenty years? ………………………
20. By whom were you employed? ………………………………………………………………………
21. If not now working, give the name and address of your last employer? …………………… ……….
………………………………………………………………………………………………………...
22. State the kind of work you were doing ……………………………………………………………….
23. When did you cease to work? ………………………………………………………………………..
24. Have you any property? ………….. If so, what does it consist of?
...............................................................................................................................................................
25. (a) What is the value of property (house, land, etc)? …………………………………………………
(b) What income is derived from it? .....................................................................................................
26. Do you live on it? ……………………………………………....………………….............................
27. Is it rented or partly rented?...................................................................................................................
28. What rent do you get? ………………………………………………………………………………...
29. Have you any money in Savings Bank or in any Bank? ……………………………………………..
30. (a) How much have you coming in each month in money? ………………………………………….
(b) Are you a recipient of Public Assistance / Disability Assistance?......... If so, how much?.............
31. (a) Are you a Government or other pensioner? ……………………………………………………...
(b) If so, how much is your monthly pension? ………………………………………………………
32. Do you pay rent for the house in which you are living? ……………………………………………..
33. How much rent do you pay and to whom? …………………………………………………………...
34. Do you belong to any Friendly Society (Give Name) ………………………………………………..
35. Has your wife/husband any property? …………… If so, what does it consist of?
………………………………………………………………………………………………………...
36. Where is it situated? ………………………………………………………………………………….
37. What is the value of the property? ……………………………………………………………………
38. Does your wife/husband live on it? …………………………………………………………………..
39. If you are a widow, state date of your husband’s death? …………………………………………….
40. Have you applied for Senior Citizens’ Pension before? …………………………………...…………
41. Do you receive Senior Citizens’ Pension in any other district? ……………………………………...
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