Member Personal Details

Member number
Unapproved policy number
Name
Date of birth
Date joined fund
Date of death
Cause of death

Calculated Amounts

Lump sum multiple of salary	1 (Unapproved)
Salary
Unapproved Benefit

Unapproved Nomination Form

Date form completed

List all nominated beneficiaries with their details as indicated. Please tick the unapproved nomination checkbox for any unapproved nominated beneficiaries already added in prior steps.

On Beneficiary Nomination Form	On Unapproved nomination form	Name and Surname	ID/Passport Number	Date of birth	Relationship	% Allocation	Distribution	Age at death of member	Current age
					Total	0%

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