FUNERAL SCHEME BENEFICIARY NOMINATIION FORM

Status of the Application

First Name & Initials

Title & Last Name

Date Of Birth

District

Marital Status

Contact No

Status of Employement

Employed

Pensioner

Ministry

Department/Division

New Employment No.

Application Date(D/M/Y)

Option Chosen

Username

UserType

Password

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Please Note The Following

the maximum entry age for pensioners is 65 years).
IMMEDIATE DEPENDANTS (Please provide FULL details of Spouse and a maximum of SIX (6) unmarried children under the age of 21)
EXTENDED DEPENDANTS (Please provide FULL details of up to FOUR (4) parents, TWO (2) Additional Children (if any) and TWO (2) other relatives. Note that there is NO age limit for parents, but there is an age limit of 60 years for other relatives.)
NOMINATED CLAIMANTS (Please provide FULL details of claimant(s) in the event of your death)
CANCELLATION OF PREVIOUS NOMINATIONS (Please provide details of previous beneficiary nominations you would like to remove from your account)