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    Form-PSSS-1-Beneficiary-Nomination (1)

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    derrick andiva
    psssss

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    Form-PSSS-1-Beneficiary-Nomination (1)

    Uploaded by

    derrick andiva
    4 views3 pages
    psssss

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    psssss

    Copyright:

    © All Rights Reserved
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    Download as docx, pdf, or txt
    4 views3 pages

    Form-PSSS-1-Beneficiary-Nomination (1)

    Uploaded by

    derrick andiva
    psssss

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    PSSS.

    PUBLIC SERVICE SUPERANNUATION SCHEME


    P.O. BOX 20191 – 00200
    NAIROBI

    Instructions on filling the Nomination of


    Beneficiaries Form (PSSS.1)

    General Instructions
    1. The form should be filled in CAPITAL LETTERS
    2. The form should be filled in duplicate with the
    employee retaining a copy
    3. No alterations whatsoever
    4. Anytime an employee changes his/her
    beneficiaries the same should be updated by filling
    a new form.
    5. The form should be filled and submitted to Public
    Service Superannuation Scheme

    Section A: Personal Details


    1. The form should be duly completed and clear
    copies of the following documents attached
    (National ID, Birth Certificate, KRA Tax-PIN).

    Section B: Beneficiaries Details


    1. Attach copy of National ID, Marriage
    Certificate/Affidavit for spouse and Birth
    Certificates, for children where applicable).
    2. Attach copy of National ID for the guardian
    NOMINATION OF P PSSS.1
    SS
    S
    BENEFICIARIES FORM PUBLIC SERVICE SUPERANNUATION

    SECTION A: PERSONAL DETAILS

    Member’s Full Name __________________________ _________________________ ____________________________


    (Surname) (First Name) (Middle Name)
    Date of Birth ______________________ National ID. No. _________________________ KRA PIN ___________________
    (DD/MM/YYYY)
    Personal / TSC No. ____________________ Marital Status __________________ Mobile No. ____________________
    Email Address ____________________________ Postal Address _____________ Code ___________ Town __________
    Home County ___________________ Sub County ____________ Location: ________ Sub Location________________

    SECTION B: BENEFICIARIES’ DETAILS


    I hereby request the Trustee to pay any benefits in my name which shall become due under the PSSS to
    the beneficiaries detailed in the proportion(s) indicated against the name of each beneficiary. (Include
    Guardian in the event that the children are less than 18 years of age).

    National ID / Birth Date of Birth Rate


    Surname First Name Middle Name Relationship Mobile No.
    Certificate No. (DD/MM/YYYY) (%)

    GUARDIAN DETAILS: In the event that children are less than 18 years old
    National ID / Birth Gender
    Surname First name Other name Relationship Mobile No.
    Certificate No. (M/F)

    SECTION C: MEMBER’S DECLARATION


    I the undersigned, recognize that my circumstances and those of the persons shown above as
    beneficiaries may change. I undertake to advise the Trustees when any change is made regarding my
    nominated beneficiaries. I understand that this form amounts to an expression of my wishes and nullifies
    any previous nominations completed and submitted.

    Member Signature: ______________________________________ Date: ___________________________________


    Witness (Name): __________________________________ Signature:____________________ Date: _____________

    SECTION D: FOR OFFICIAL USE ONLY


    Member No. __________________________
    Received by (Name)____________________________ Signature:________________________ Date: _____________

    Public Service Superannuation Scheme, P.O. BOX 20191 – 00200 Nairobi

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