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Of my wish that the gratuity, which may be payable upon my death, be paid to the beneficiaries mentioned below and in the proportion indicated by me. A) PARTICULARS OF MEMBER 1. Pension No. 2. Salary No. 4. Title 3. Surname 5. First name 6. Middle names 7. ID No. 9. Date of birth 8. Passport No. C C Y Y M M D D 10. Pension fund 11. Employer Name B) BENEFICIARIES 1. Surname First name Middle names ID No. % , Percentage of benefit Postal address C Date of birth C C Y Y Tel No.

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