National Insurance Board

For ease of reference, please see attached forms for the National Insurance Board (NIB) Employer’s Certificate Med-4 form and Termination of Service/Lay-Off Certificate.


The Employer's Certificate - Med 4 form, is required to support claims for the benefits should employees become sick or are injured. Employers are only required to complete the Med 4 form and a copy kept for your records.

The Termination of Service/Lay-Off Certificate should be completed by Employers with the intention of allowing employees to come back to work.

Employers can fill in the forms and employees can drop off to NIB’s drop box at one of their locations or email the form to


Feel Free to let us know if you have any questions.

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