Beneficiary nomination form

To the Corporate Trustees / Trustees of

Full name of scheme (BLOCK CAPITALS) Name of member (BLOCK CAPITALS) * Company 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 the dependant details below.

Dependants *

Dependant 1

Surname First names

Gender Male Female

Date of birth Percentage of benefit

Relationship Contact tel. no

Physical address

Dependant 2

Surname First names

Gender Male Female

Date of birth Percentage of benefit

Relationship Contact tel. no

Physical address

I the undersigned, have read the notes on this form and fully understand the contents. I have included all my dependants. I recognise that my circumstances and those of the persons shown as dependants and/or nominees may change, and I accept that I must advise the Trustees of the Scheme when any change should be made. Members may review and update this form at no cost, and must do so 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.

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
Other persons who the member is obliged to maintain under the Children’s Act, 1998 (Act 560) or otherwise
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
Persons for whose maintenance the member would have become legally liable if he or she had not died (for example an unborn child)

b) The deceased member’s family includes the dependants of the deceased and nominees who have been validly nominated as beneficiaries. If a member has not nominated anyone, or where the nomination is considered invalid, the Trustees will direct distribution in accordance with the Intestate Succession Act, 1985 (P.N.D.C.L. 111). If the deceased member fails to nominate a surviving spouse and children, they may apply to a court to amend the beneficiary nomination form to include them.

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

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. Percentages of benefit indicated must total 100%.