Form Pens.e/2 - Instructions For Payment Of Disability Or Death Benefit(S) Page 2

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UNITED NATIONS JOINT STAFF PENSION FUND
INSTRUCTIONS FOR PAYMENT OF DISABILITY OR DEATH BENEFIT(S)
I M P O R T A N T
PLEASE PRINT OR TYPE
PLEASE ENTER PENSION NUMBER
I, __________________________________________________________________________________
(SURNAME)
(FIRST)
(MIDDLE)
hereby submit payment instructions for the benefit(s) that becomes (become) payable under the UNJSPF Regulations.
CURRENCY OF PAYMENT:_________________________
ACCOUNT TYPE: _______________________________________
(Please Specify)
(Checking/Savings)
NAME OF FINANCIAL INSTITUTION
BANK ACCOUNT NUMBER / IBAN
(SWIFT CODE of Financial Institution)
Please provide any other bank identifiers like local routing codes (e.g., ABA,
ABI/CAB, BLZ, Sort code, etc.)
(ADDRESS)
(CITY, STATE, POSTAL CODE, COUNTRY)
NOTE: To facilitate transfer of funds, please provide a document from your bank indicating bank codes and preferred routing for international
payments.
My Contact details:
Mailing Address:
___________________________________________
E-Mail:____________________________________
(Street)
Telephone
___________________________________________
Number: (_________) ___________-___________
(City)
(Zip code)
___________________________________________
(
State)
(Country)
Emergency Contact Details:
Name / Relationship: ___________________________________________
E-Mail:_____________________________________
Telephone
Mailing Address:
___________________________________________
Number: (_________) ___________-__________
____________________________________________
Date: __________________________________
B e n e f i c i a r y ’ s S i g n a t u r e
1
(
Day) (Month) (Year
IMPORTANT: BENEFICIARY’S SIGNATURE WITNESSED, VERIFIED AND CERTIFIED AS AUTHENTIC BY:
______________________________________________
(Print Full Name of UN Officer or Governmental Authority)
______________________________________________
(Official Title)
_______________________________________________
Date: ___________________________
1
AFFIX OFFICIAL STAMP HERE
(Signature)
(Day) (Month) (Year)
1
The completed form bearing ORIGINAL SIGNATURES must be submitted to the Fund; no faxes or e-mails will be accepted.
Page 2 of 2
PENS.E/2 (06/7)-E

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