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Forms
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NII forms for submitting a claim for benefit and for matters of insurance and collection of insurance contributions.
The forms are in PDF format. For viewing or printing them you need Acrobat Reader, available for free on the internet. To download Acrobat Reader and for guidelines, click here.
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| Form | Order | Download | Fill in |
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| 17 - Waiver for Insurance Companies |  A waiver which allows a person to receive information regarding an insured person, on condition that this person has agreed and signed to this effect. |
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| 20 - Request for Grant for Justice Reasons |  There are circumstances under which the NII is forced to deny a claim, even if this causes an obvious injustice. These cases include non-fulfillment of instructions for one reason or another. In such cases, grants may be provided under Article 387 of the NI Law, which states: “The NII may decide to grant a cash or in-kind benefit according to tests and rules and of an amount authorized by the Labor and Social Affairs Committee.” |
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| Form | Order | Download | Fill in |
| 5400 - Payment Under the Maintenance Law |  Claim for women with alimony verdict in hand, requesting the payments directly from the NII since the person who owes her the alimony is not paying her directly. The form is to be personally submitted at the local branch together with the necessary documents. |
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| 5015 - Study Grant |  The form is for parents who are divorced, single or widowed, separated, Agunah, and a new immigrant who has been in Israel for one to two years. |
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| 103 - Employee Card |  To be filled out by an insured person classified as an employee at the beginning of employment and of each tax year. |
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| Form | Order | Download | Fill in |
| 2600 - Claim for Long-term Care Benefit |  Claim form for elderly people of old age living at home who need the assistance of others in performing everyday functions. Those eligible for the benefit will receive long-term care services and not a cash benefit. |
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| 330 - Risk Pregnancy Benefit Payment Claim |  This form is for women who cease work due to the need for precautionary rest as a result of a risk pregnancy, in accordance with medical authorization of a gynecologist. In order to be eligible for payment, the risk pregnancy must be of at least 30 consecutive days and there is no eligibility for payment for risk pregnancy from any other source. |
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| Claim for Special Grant to Work Disabled - 266 |  A work-disabled person with a 65% medical disability in his legs or a total 75% permanent medical disability may be eligible, under certain conditions, for a grant to adapt his living conditions, for accessories and for a vehicle. |
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| 271 - Application for an Advance/Loan/Conditioned Grant |  A work injured person may, in certain circumstances, be eligible for an advance payment on his monthly pension in order to begin rehabilitation. Under Regulation 113 of the National Insurance Law, the NII may authorize capitalization for various purposes if it is proven that the claimant has a permanent income sufficient for his subsistence or a reasonable chance of such an income. |
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| 1521 - Payment Claim for the Grant |  Application for payment of the grant to discharged soldiers who worked in a preferred/required job and girls who served two years in the voluntary National Service. |
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