yw \VINPF/ EMP/ 03 VANUATU NATIONAL PROVIDENT FUND CHANGE OF NATIONAL EMPLOYER DETAILS FORM | EMPLOYER INFORMATION 1. Business Name: 2. Trading Name: 3. Commencement Date: 4, Employment Date: 5. Licence Agent 6. Licence Number: M- CONTACT DETAILS 1.€mail Address: 2. Contact Number Ill: BUSNESS ADDRESS: 41. Address Type: 2. Postal! Zip Code: 3.Line 4 4. Line 2 5, Provine/State: 6.IslandiDistit: 7. Location: vO ra) 8. Municipality/City: EGISTRATION DETAILS 1.VNPF Number: 2. VIPA Number: 3. VFSC Number 4. Place of Registration: 5. Employer Contribution Rate: 6. Employee Contribution Rate: T.Communication Language: 8. Business Type: —] 9. Business Category (OFFICE USI 410. Employer Type (OFFICE USE) lV - APPLICATION DETAILS (OFFICE USE) 1. Employer Type: 2. Employer Sub Type: =) 4. Employer Category: 5, Received Mode: 6. Received Branch’ 8. Received Date: —] ©. Applied By: 410. Applied Date: 11. Entored By: 12. Entered Date: Page 1\VNPF/ EMP/ 03 VI_- NEW BRANCH ag eee 1 Vil - BRANCH ADDRESS 1. ackress Type 2 Postal Zp Code ] aProeerSale dine [ ] 5 isendisi 6 tinea If ] 7. ation muni ly ] Page 2Vill - LIST OF CONTACT \VNPF/ EMP/ 03 ae Leas aa aa 9. National ID Number: 10, Passport Number: 42 Start Date: 48. End Date: 14, Mobile Number: 16, Office Number: ——______ IX- RESIDENT ADDRESS. 1. Adgress Type: 2. Postal! Zip Code: 3. Province/State: 4, Line 4 5. Island/District: 6. Line 2: 7. Location: 8, Municipaity/City: 9, Submit your ID Photo: Page 3VINPF/ EMP/ 03 X-LIST OF VEHICULE 4. Busnes Leence Name ee ee cc 2. Busnes Leenee Agen 4 Ohasse Nuroer [ ] 5. Engine Number 6 Pate inbox 7. Divers Leen Number 6. Etecive Date 9. Permit Expiry Date: 10. End Date: [ ] 11. Pet Type 12, Divers Name (oa) Page 4\VNPF/ EMP/ 02 XI- EMPLOYEE LIST A- EMPLOYEE DETAIL 1. VNPF Number: 2 Fist Namo a ae [ 5. Dao of Bit 6 Start Date: ) 7d Date NEF Status a ss ; ee 11. Monty Salary. 12 Pay Frequency B - OCCUPATION DETAILS 1. Branch 14. Total Contbuton Rate 15. Category (Refer to list): 16. Type: eS) 17 dob Designation 18: Employment Stas Type | ae — * C= ve Page 5Xil- BANKING INFORMATION \VNPF/ EMP/ 03 4. Bank Name: 2. Branch Name: 3. Aczount Number: 4. Account Type 5. Swit Number: 6. Start Date: 7. End Date: 8. Address: Page 6\VNPF/ EMP/ 03 Xill - DECLARATION OF EMPLOYER | certify thatthe information given in this form are true and correct to the best of my abiity 4. Filled By: 2, Filled Date: 3. Full Name: 4. Position in Business: 5. Signature: 6. Company Seal: Page 7