Form Wp1002 - Nomination Of Beneficiaries - National Treasury
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3WP1002
National Treasury
G.P.-S.026-0842
Pensions Administration
NOMINATION OF BENEFICIARIES
Bar Code
SEE INSTRUCTIONS OVERLEAF
I hereby give notice of my wish that the gratuity, which may be payable upon my death, be paid to the beneficiaries mentioned below and in the
proportion indicated by me.
A) PARTICULARS OF MEMBER
1. Pension No.
2. Salary No.
3. Surname
4. Title
5. First name
6. Middle names
7. ID No.
8. Passport No.
10. Pension
9. Date of birth
C
C
Y
Y
M
M
D D
fund
11. Employer Name
B) BENEFICIARIES
1. Surname
First name
Middle names
%
,
ID No.
Percentage of benefit
Postal address
C
O
D E
C
C
Y
Y
M
M
D D
Date of birth
Relationship
Tel No.
C
O
D E
Cell No.
2. Surname
First name
Middle names
%
Percentage of benefit
,
ID No.
Postal address
C
O
D E
Date of birth
C
C
Y
Y
M
M
D D
Relationship
C
O
D E
Cell No.
Tel No.
3. Surname
First name
Middle names
%
ID No.
Percentage of benefit
,
Postal address
C
O
D E
C
C
Y
Y
M
M
D D
Date of birth
Relationship
C
O
D E
Cell No.
Tel No.
ALL PAGES OF THIS FORM MUST BE COMPLETED IN ORDER FOR THIS FORM TO BE VALID AND THE MEMBER AND
61779
THE WITNESSES MUST INITIAL THIS PAGE
Page 1 of 3
Member initial
Witness1
Witness2
Initial
Initial
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