Pfa Complaint Form Page 2
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4EMPLOYER’S DETAILS
Name of the
Company:
Address of
Company:
Tel:
Contact Details of company:
Fax:
E-Mail:
Date of Joining
the Company:
Date of Leaving
the Company:
SUPPORTING DOCUMENTS: ATTACHED
Mark X in appropriate boxes where supporting documents are attached
Identity Document (ID) of complainant and/or
member belonging to the fund
General:
Benefit Statement / Payslip
Any Correspondence / Letters from Fund or
Employer
Divorce Matters: Divorce Order with Settlement Agreement
Disability
A Copy of Disability finding/report
Matters:
Retirement
Policy Number
Annuity:
Death Benefit
Copy of the Member’s Death Certificate
Matters:
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