Standard Notice Of Retirement Form
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2Appendix 1
STANDARD NOTICE OF RETIREMENT
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Affix Recent
Passport
Photograph
1.
Account Holder’s Particulars:
Surname
First Name
Middle Name
PIN
Date of Birth
Sex (M/F )
Effective Date of Retirement
Marital Status (M/S/D/W)
(dd/mm/yy)
(dd/mm/yy)
Permanent Home
Address:
Current Contact/
Mailing Address:
House Tel. Number
Mobile Tel Number
2.
Current Employment Details:
Employer’s Name
and
Address
Employer Code
Total Annual Remuneration N:
(
(
( Attach Pay Slip)
3.
Details of Benefits:
N
Accumulated Contributions to Date:
Status of Retirement Bond N
(If a public sector employee)
Expected Contribution to Date of Retirement N:
Status of Accrued Benefits N
(if a private sector employee)
4.
Reasons for Retirement/Exit (Please tick appropriately)
Normal
Retirement
Medical
Terms and Condition of Employment
a.)
If on Medical Reasons:
Medical Condition:………………………………………………………………………………………………………………………………………...
……………………………………………………………………………………………………………………………………………………………..
Name and Address of Physician/Hospital that issued the medical certificate: ……………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………….
Date of Medical Certification
(dd/mm/yy)
b.)
If under Terms and Conditions Of Employment:
State Unique Terms and Conditions of employment:
…………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………
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