Beneficiary Nomination

BENEFICIARY NOMINATION FORM

To the Corporate Trustees / Trustees of

Full name of Scheme in BLOCK CAPITALS

NAME OF MEMBER (BLOCK CAPITALS): *

Company Employee Number (please ignore if you have no employee number)

NAME OF EMPLOYER: *

Branch/Site/Plant: *

In accordance with the National Pensions Act (2008) Act 766, a member's dependants and persons whom the member has nominated as beneficiaries although they are not dependants must be taken into account by the Trustees when they decide how the member's lump sum benefits are to be paid in the event of a member's death. To assist the Trustees in making their decision please complete Section 2, 3 and 4 below

DEPENDANTS: *

Surname

First Names

Gender

Male
Female

Date of Birth

Percentage of Benefit

Relationship

Contact Tel. No

Physical Address

I the undersigned, have read the reverse side of this form and fully understand the contents of this form and I have included all my dependants. I recognise that my circumstances and those of the persons shown above as dependants and/or nominees may change. I accept tha t it will be necessary for me to advise the Trustees of the Scheme when any change should be made regarding my dependants and/or nominees. The Fund shall allow members to review and update their beneficiary nomination forms and when circumstances surrounding the dependants and nominees change at no cost. It is mandatory for members to review and updat e their dependants and nominees at least once every five (5) years.

Member´s Name *

IDENTIFICATION NUMBER: *

Member´s Signature

Date

DISPOSAL OF LUMP SUM DEATH BENEFITS (THIS EXPLANATION IS NOT A LEGAL DOCUMENT - THE WORDING OF THE ACT IS DEFINITIVE)

In accordance with the National Pensions Act (2008) Act 766, a member’s dependants and persons who are not dependants but who are nominated by the member must be considered by
the Trustees when making decisions on how to distribute the lump sum benefits payable on the death of a member.

PLEASE LIST YOUR BENEFICIARIES ON THE OTHER SIDE OF THIS FORM AFTER YOU HAVE READ THE FOLLOWING NOTES.

Briefly, the position is as follows:

a) The National Pensions Act (2008) Act 766 defines dependants as:

Members of the family of a member as specified in the Schedule, Section 213 of the Act and
Other persons who the member is obliged to maintain under the Children’s Act, 1998 (Act 560) or otherwise or;
Persons who were dependent on the earnings of the member at the time of the member’s death.
Persons whom the Trustees consider to have been dependent upon the member at the time of his/her death;
The spouse and children (both minor and major) of the deceased member; and
Persons for whose maintenance the member would have become legally liable for if he or she had not died (for example an unborn child)

b) The National Pensions Act (2008) Act 766 defines dependants as:

i) the deceased member’s family who are:

a. The dependants of the deceased; and
b. Nominees who have been validly nominated as beneficiaries of the deceased;

ii) if a member has not nominated anyone or where the nomination made is considered by the Trustees to be invalid, then the Trustees will direct for the distribution of
the member’s lump sum death benefit to the dependants in accordance with the Intestate Succession Act, 1985 (P.N.D.C.L. 111)

ii) If the deceased member fails to nominate a surviving spouse and children as beneficiaries in his beneficiary nomination form, the spouse and children may apply to the
court of law for the court to amend the beneficiary nomination form to include them.

c) Section 81(7) also provide that where the deceased member has children, then sixty percent (60%) of the lump sum death benefit will be distributed to the deceased’s
children and forty percent (40%) of the benefit will then be distributed to nominated beneficiaries.

d) Where the lump sum death benefit has been paid to validly nominated beneficiaries or according to a varied order of court, then no other person or party may raise any further
claim against the Fund.

NOTES

the fact that a person is classified as a dependant or nominee does not mean that the Trustees must award him or her any benefit from the Scheme;
the requirements set out above do not apply to pensions payable to spouses or dependants in terms of specific provisions of the rules; such pensions are payable as
described in the rules;
any alterations or deletions on the forms must be initialed (abbreviated signature);
the percentage of benefits indicated must total 100%.