All correspondence to be

addressed to:

C a t e r in g I n d u s t r y P e n s io n F u n d

THE PRINCIPAL OFFICER

Telephones:
704658/703852/703855
704564/704573
774126/774128

87 Selous Avenue, Harare; 50 Hofmeyer Street, Masvingo

04-704 5731703 852; 039-264 805

Fax: 704016
P.O. Box 3416
HARARE

APPLICATION FORM FOR A DEATH BENEFIT

1.

Name of deceased.....................................................................................Pension Number.......................................

2.

Last place o f employment............................................................................................................................................

3.

Marital status of deceased: Single/Married/Divorced/Widowed (Delete Inapplicable)

4.

BENEFICIARY PARTICULARS
i.

Name o f beneficiaiy................... if .... .........IB !!..... ................gjjgjj....... IJD. No.........................................

ii.

Address....I................................................,.1(.

iii.

Relationship to deceased.................. ..................................................................................................................

....... nS............ ...............................................................

If beneficiary is a wife please attach certified photocopies of the following documents:

a.
b.

Long version children's birth certificates

1 Marriagecertificate

c.

National ID. Certificate of Applicant

If beneficiary is any other person as listed in the Statutory Instrument 323 of 1991 Subsection 2b of clause 28:
To enclose:
a.

Certificate of heir/ Guardianship

b.

Affidavit

c.

National I.D. Certificate of Applicant

Method of payment required

(Delete inapplicable).............................Collect / post to above address

In addition to the above this form should be accompanied by a copy of the deceaseds Death Certificate.

Date:.............................................................20....................

Signature of Applicant..................................................

Witnessed by..........................................................................(Print name of Officer)

REGIONAL OFFICES:

BULAWAYO
214 ANCHOR HOUSE
FORT STREET/12THAVE
TEL: 09-889462

GWERU
21 DEVELOPMENT HSE
2ND FLOOR
7TH STREET
TEL: 054-223270

MASVINGO
8 KYLE HOUSE
TEL: 039-264805

MUTARE
18 VICTORY HSE
TEL: 020-65024

KARIBA
STAND 743
OLD KARIBA BAKERY
C/O KARIBA HEIGHTS
TEL: 061 - 3002