SGA GALIFE PERSONAL PENSION PLAN - CLAIM FORM WEMBER DETAILS (ALL THE BELOW DETAILS ARE MANDATORY) mennenS NE PHLEeMol BMMANuEL We ee EMPLOYER'S NAME QuAuiee ereoveqs sD) wr) DATE OF JOINING SCHEME ee UA FROM oglos/1987 (DDIMMIYYYY): DATE OF WiTHORAWAL LAST MONTH OF SCHEME (ODIMMYYYY) t2{ofa0e22 | CONTRIBUTION: Se(femeee| MEMBER'S PERSONAL MOBILE "¢ NUMBER. 0726097 OE | MENBERSPINNUMBER | & QO .sy7¢004h MEMBER'S PERSONAL EMAIL ADDRESS: WREMMANLAOSD AGmmL-ram WITHDRAWAL TYPE (TICK ONE OF THE BELOW) LEAVING JOB [TATE RETIREMENT T DEATH (PLEASE PROVIDE DEATH CERTIFICATE) TRANSFER OUT OF THE SCHEME TLLHEALTH RETIREMENT PERMANENTLY EMIGRATING FROH KENYA (PLEASE (PLEASE PROVIDE MEDICAL REPORT) PROVIDE PROOF) EARLY RETIREMENT PAYMENT TO BENEFICIARY/IES) IN CASE OF DEATH NORMAL RETIREMENT WITHDRAWAL BENEFITS INSTRUCTIONS ‘MEMBER CONTIBUTING FUND EMPLOYER FUND. CASH COMMUTATION (SUBJECT TO DEDUCTION OF APPLICABLE TAXES) {ioe )% { Ve "TRANSFER TO ANOTHER REGISTERED SCHEME* { )% (_y% TRANSFER TO GA LIFE PERSONAL PENSION/PROVIDENT PLAN: 6 1% (TAX-EREE TRANSFER) ( } ( F TOTAL 700% 10% “PROVIDE DETAILS OF THE SCHEME NAME AND PROVIDER & ENCLOSE COPY OF SCHEME REGISTRATION CERTIFICATE: ‘SCHEME NAME MEMBERSHIP NUMBER, PROVIDER NAME MEMBER BANK DETAILS: ‘Account Name: “Account Number Bank Name: ‘Bank Branch SIGN OFF: MEMBER NAME* (‘in case of Member's death oril-heatth ths form can be signed by all ofthe Member's nominated beneficiaries) MEMBER SIGNATURE DATE heer. MANDATORY: MEMBER'S ID/PASSPORT COPY AND PIN COPY SHOULD BE ENCLOSED TO THIS CLAIM FORM EMPLOYER'S AUTHORISED SIGNATORY NAME EMPLOYER'S AUTHORISED POSITION : EMPLOYER'S AUTHORISED SIGNATURE DATE: STAMP: