Forms

Forms

There are 12 forms

Below are the list of forms available

Contributors' processes form

Contributors' processes form is used in all processes taking place on contributor's record (enrollment, retrospective enrolment, retrospective disqualification, amending reason of disqualification, cancelling period, amending coverage, amending wage, updating contributor information, amending job title, amending occupation in Nitaqat program, special expatriate, emigrant tribes, amending nationality). Further, the form includes demonstration on method of filling in the form and documents requested for each service. Application may be submitted by employer or contributor.

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Reimbursements processes form

Compensation process form is used when beneficiary, his family members or representative thereof apply for one of the following services (Retirement, early retirement, retirement with adjoining nominal period, amending beneficiary status, occupational disability, non-occupational disability, family members' benefits, death attributing to work injury, one-payment reimbursement, changing authorized person/ bank, request for commitment/bank cancellation, issuing card). Further, the form includes clarification on how to complete the same and documents to be attached for each service. 

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Form No 24/ Medical Boards

This form is used by the contributor who wishes to join the Voluntary Contrubtion Scheme (Medical examination). Avaliable only in Arabic

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Occupational risks processes form

Occupational risks processes from is used in all processes serving injured persons being covered under occupational risks branch in terms of (recording work injury, rectifying injury information, transferring contributor's file to hospital/office, payment of daily allowances, traumatic death ? cancel injury notification/ relapse, payment of disabled/remains repatriation, payment of medication cost, occupational disease, approve treatment completion, payment of residence/transfer costs, add /change hospital, relapse/ complication, submit to the committee, transfer dues of contributor outside the Kingdom) work injuries/traumas or death attributing to work injury, or approval to complete treatment and whatever relates to the injured contributor. Further, the form includes demonstration on how to fill in the form and documents required for each service.
 

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Unified Form for the Insurance Extension Law

This form is used by employers to register Saudi Workers, working in the private sector in GCC countries. Please fill out the form, print it, then submit it to the nearest office.unified Form for the Insurance Extension Law. Available only in Arabic.

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Employer's form

Employer's form is used in all processes taking place on organization's register (data amendment ? exemption from penalties ? paying indebtedness in installment ? refund payment in increase/fault ? change treatment entity ? electronic services ? change the head office ? request central registration ? request organization's ownership transfer ? terminate organization's business). Further, the form includes demonstration on how to fill in the same and documents requested for each service.
 

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Optional Contribution processes form

 The form is used in all processes related to the optional contribution in terms of (new contribution, amending contribution slide, cancel contribution, suspend contribution). Further, the form includes demonstration on how to fill in the same and documents requested for each service in addition to tables for monthly income slides under which contributions are calculated
 

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Beneficiaries and Dependents Processes Form

Family members and dependents process form is used upon applying for addition or removal of family member or dependent because of working or studying. 

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Aggregation Request Form

The form is used in processes related to services between civil and military retirement system and social insurances system (application for enrollment to insurances; the first system ? abandonment of application for enrollment to the insurance; last system). Further, the form includes demonstration on how to fill in the form, conditions and documents requested for each service.

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Supplement to Reimbursement Processes Form Download file here

The supplement form of compensation process is used if the number of family members or dependents exceeds five (5) members, or if there is more than one account for family members. 

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Dependency Verification Acknowledgment Form

Dependency verification acknowledgement form is upon applying for dependency verification related to family member's pension, or to apply for verifying dependency in relation to contributor's eligibility for family burdens subsidy. 

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نموذج الاعتراض الموحد على قرار اللجان الطبية الابتدائية

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