8/18/2019 CIPF Retirement Appy Forms

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CATERING INDUSTRY PENSION FUND50 Hotmeyer St. Tatenda 0773 484 980

Masvingo MrMandeya 0773 199 526039-264 805

RETIREMENT APPLICATION FORM

1.PENSION FUND NUMBER .......................................................

2.SURNAME .......................................................

3.OTHER NAMES ........................................................

4.DATE OF BIRTH ........................................................

5.1.D. NUMBER .........................................................

6.POSTAL ADDRESS .........................................................

7.CELL/TEL NUMBER

8.BANK& BRANCH

ACCOUNT NUMBER

9.MONTH OF LAST

CONTRIBUTION

lO.EMPLOYMENT HISTORY IN THE CATERING INDUSTRY

PLACE OF EMPLOYMENT DATE STARTED DATE FINISHED

I CERTIFY THAT THE ABOVE INFORMATION GIVEN IS CORRECT

Signature......................................... Date...................

8/18/2019 CIPF Retirement Appy Forms

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CATERING INDUSTRY PENSION FUND

MEMBERSHIP PARTICULARS

Membership No:......................................................................

Surname / Family Name:........................................................

Personal Name:......................................................................

National Registration No:........................................................

Old R.C. N o:..........................................District:...................

Village:....................................................................................

Chief:......................................................................................

Date of Birth:............................................................Sex M/F

Marital Status: Single / Married / Widowed / Divorced / Separated.

Nationality:...................................................................................................................................

Nature of Employment:...............................................................................................................

Occupation N o:...................................................................... Grade:......................................

Date of Engagement:...................................................... x.........................................................

Name of Employer/ Establishment:.............................................................................................

Residential Address:....................................................................................................................

Date:.......................................................... Signature:..............................................................

Before completing the following letter, your attention is drawn to the requirement of the Registrar of

Pension Funds that if you have any dependants you must nominate a dependant or the person whowill assume responsibility or those dependants, as your beneficiary.

The Manager,Board of Trustees,Catering Industry Pension Fund.

P.O. Box 3416HARARE

In terms of the Rules of the Catering Industry Pension Fund, I, the undersigned, whose

particulars are recorded above, do hereby declare nominee and appoint

Name:.........................................................................................................................................................

 Address:................................................................................................................... .

Relationship:.................................................................................................. Age:....

to receive any benefits arising from my membership of the said Fund after my death.

Date:.................................................................. Signed:...........................................

Witnessed by:................................................ in my presence.

Print Name:................................................................................... ...............................

ORIGINAL [ ] Receipt No................. *

DUPLICATE [ ] ...................................

TRIPLICATE [ ]

CHECKED:

RECORDS:

COMPUTER [

EST. CARD [

MEMB.CARD [

STRIPDEX [

DIARY [

FILE [