Signature Beneficiary. of Date. 4.8 (Financial Service Provider) Part. 5 Banking Details Beneficiary of Surname. 5.1 Full Names. 5.2 Relationship 5.3 to deceased member. Account Name. 5.4 [Indicate Bank Name. 5.5 Bank Windhoek First National Bank NedBank Standard Bank NamPost (x)] with a cross Branch Name. Branch Code 5.6 Account Number. 4.7 Account Type. 5.8 Cheque Savings Other: : Postal Address. 5.9 Cell Telephone No. 5.10 phone and Signature Beneficiary. Date. 5.11 of Part. 6 Next of kin to the deceased, other than the beneficiary (if the member is the deceased) Full Names Surname. 6.1 and [Indicate Title. 6.2 Mr Mrs Miss Dr Proff. Other (x)] : with a cross [Indicate 6.3 Marital Status Single Married Divorced Widowed (x)] with a cross Date Birth. 6.4 of ID Number. 6.5 Residential Address. 6.6 Telephone No. 6.7 - work Telephone No. 6.8 - home Fax No. 6.9 Signed 6.10 at (place) Claimant’s Signature Date 6.11 _________________________________________ ___________________________
4.8 Signature of Beneficiary. (Financial Service Provider) Date. Part. 5 Banking Details of Beneficiary 5.1 Surname. 5.2 Full Names. 5.3 Relationship to deceased member. 5.4 Account Name. 5.5 Bank Name. [Indicate with a cross (x)] Bank Windhoek First National Bank NedBank Standard Bank NamPost 5.6 Branch Name. Branch Code 4.7 Account Number. 5.8 Account Type. Cheque Savings Other: : 5.9 Postal Address. 5.10 Cell phone and Telephone No. 5.11 Signature of Beneficiary. Date. Part. 6 Next of kin to the deceased, other than the beneficiary (if the member is the deceased) 6.1 Full Names and Surname. 6.2 Title. [Indicate with a cross (x)] Mr Mrs Miss Dr Proff. Other : 6.3 Marital Status [Indicate with a cross (x)] Single Married Divorced Widowed 6.4 Date of Birth. 6.5 ID Number. 6.6 Residential Address. 6.7 Telephone No. - work 6.8 Telephone No. - home 6.9 Fax No. 6.10 Signed at (place) 6.11 Claimant’s Signature Date _________________________________________ ___________________________
CLAIM-FORM-A-Death.docx