Form Fw02n - Nominee Claim Withdrawal Application - Fiji National Provident Fund (Page 2 of 4) in pdf

Form Fw02n - Nominee Claim Withdrawal Application - Fiji National Provident Fund Page 2

Please complete this form if you have been nominated to receive member’s fund in the event of death. Please complete in pen using

BLOCK letters. Print “X” to mark boxes where applicable and ensure that the form is complete before submission.

Note: It is an offence under the Fiji National Provident Fund Decree, 2011 to make any false statement or to produce any document

which is false. Please sign against amendments made and usage of correction fluid/tape is not allowed. Refer to the explanatory

notes on page 4 when completing this form.

SECTION A - PERSONAL DETAILS OF DECEASED

1. Surname of Deceased:

First Name:

2. FNPF ID:

SECTION B - PERSONAL DETAILS OF NOMINEE

1. Name :

2. TIN Number :

3. FNPF ID:

4. Father’s Name:

5.Mother’s Name:

6. Relationship to Deceased

(DD/MM/YY)

Date of Birth

8. Phone Contact: H

9. Email:

10. Current Employer:

11. Correspondences Address:

(Postal/Residential)

12. If under 18 year of age, please provide name and address of parent/guardian (Funds will be payable to High Court)

SECTION C: WITHDRAWAL OPTIONS (APPLICABLE ONLY TO SOLE NOMINEE)

If you are the spouse and sole nominee of the deceased, you are eligible to purchase a retirement package, as per FNPF Decree

Section 56 (4). Please indicate the relevant option (s) you wish to take and where you would like the interest to this full withdrawal

added.

OPTION ONE– LIFE PENSION

I wish to receive a LIFE PENSION

SINGLE PENSION of $

Whole

Part

If part pension, I would like this interest to be added to the amount above.

Yes

OPTION TWO – TERM ANNUITY

I wish to allocate the amount specified below the Term of (you may choose one or any combination of the following and the cor-

responding amount on the space provided)

5 years $______________

10 years $______________

15 years $ ______________

OPTION THREE – LUMP SUM WITHDRAWAL

I wish to receive a LUMP SUM

Whole

Part

If part lump sum, I would like this interest to be added to the amount above.

Yes

Form Fw02n - Nominee Claim Withdrawal Application - Fiji National Provident Fund Page 2

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