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We offer several forms for download in Portable Document Format (PDF). PDF files are printer-independent.

These forms should be printed on 8 1/2" x 11" or 8 1/2" x 14" white paper. We recommend that print quality be adjusted appropriately to render these forms acceptable to the ABSSB.

To read and print a PDF publication, the Adobe Acrobat Reader software must be installed on your PC. You can download the Adobe Acrobat Reader version suitable for your system by clicking on the link below. This software is free of cost.

 Get Adobe Acrobat

Form
Description
C3











These forms are submitted by employers in respect of their employees from January to June & and from July to December. They show the employees' :

  • Full name,
  • Addresses,
  • Registration numbers
  • Occupation,
  • Date of Birth
  • Period of employment
  • Employee's signature.
Certificate of Confinement



This form is completed by a doctor or a midwife indicating the confinement date of the insured.

Employees or Self-Employed


This form is completed and submitted by persons wishing to be registered as self-employed.

Maternity Benefits



This form is submitted to the office by the insured employee for the application of maternity benefits.

R5A (Private Industry)
R5A (Government)




Also known as monthly remittance forms. These are submitted to the Social Security office on a monthly basis. They show the employees' earnings, both employees' & employers' contributions and the number of weeks worked within the month.
Employers Registration Form


This form is completed and submitted by persons wishing to be registered as new employers
Overseas Life Certificate



This form is submitted to the office by persons residing overseas who is in receipt of an Age Pension.
Local Life Certificate



This form is submitted to the office by persons residing in Antigua and Barbuda who is in receipt of an Age Pension

Employees Refund Form

This form is completed and submitted by insured employees wishing to apply for a refund.

 



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