Minet /ALMASI BEVERAGES LTD STAFF RETIREMENT BENEFITS SCHEME - LEAVER'S FORM. Payroll Number entity Card No. Name of Member Employing company Date of Birth : Date Joined Service: KRAPin No Date of Leaving Date of last contribution Reason for Leaving. (tick one box below) NormatRetiement [J Early Retirement teats Retirement Deathin service o Resignation o Dismissal oo Confirmation of Benefit Choice by Member Pleace state proportion (x) to be taken as immediate lumpsum: Employee Contributions plus interest Employer Contributions plus interest Please state how the deferred amount should be treated: ‘Transfer Benefits Name of Scheme to be Transferred to, Retain Benefits in the Almas! Beverages Ltd Staff Retirement Benefits Scheme. Forwarding Address: P.0.Box. Code No. \ Town Tele: Emalladdress Bank Details ‘Account No Bank: Branch Name Signature Date ‘Tobe completed by the Trustees. Prepared by: Date: stamp: