Section A - To be completed by employee

Member’s particulars (please complete in full)

EMPLOYER’S DECLARATION

It is hereby confirmed and warranted that the information contained herein is correct. The Employer hereby unconditionally absolves the Fund Trustees and Zamara as necessary and indemnifies and keeps indemnified the Fund Trustees and Zamara from and against all and any loss, damage, costs and expenses which the beneficiaries, or any other person whatsoever, may sustain or incur, either directly or indirectly as a result of Zamara, on behalf of the Fund, relying on and using any information supplied by the Employer, specifically where the Employer has failed to obtain the beneficiary’s signature on this notification.

Section B - To be completed by member (please complete all sections)

Member’s particulars (please complete in full)

Please verify that the details contained in Section 1 is accurate. Also fill in your contact details as below.

Banking Details

If the benefit is to be paid directly to YOU by Zamara, please ensure that the banking details section below is completed in full, (if applicable).

Please Note:

  • Ensure that the bank account details supplied are in respect of your own account.
  • All cheques issued are ‘NOT TRANSFERABLE’ and must be deposited into the payee’s account

Section C - To be completed by member

Please read the document on options available to members on Exit before you fill in this section. The document is available from the Human Resources Office or from the Fund Trustees;

MEMBER’S SIGNATURE & DISCHARGE

I have read the benefit options in respect of my benefits from the Fund and hereby select the option indicated below (tick box).

Options available on retirement or emigration

MEMBER’S SIGNATURE & DISCHARGE

I hereby confirm that:

  • I have read the benefit options available in respect of my benefits from the Fund and confirm the selected benefit payment options in respect of my benefit from the Fund as selected above;
  • Payment of my benefit as specified hereinabove represents full and final discharge of the Fund obligation to me in respect of my benefits under the Fund other than any benefit that I have opted to preserve in the Fund;
    I hereby confirm that this release and discharge shall bind my heirs and personal representatives;
  • Any retained benefits will be paid to me in accordance with the Fund Rules and prevailing legislation;
  • The details provided herein, in particular my contact and banking details are true and correct in every way.
  • I understand the options available to me regarding the payment of my benefits, including the withholding tax implications and confirm that I am making an informed choice; and,
  • I understand that failure to, or delay in, selecting and communicating my preferred option to Zamara or the Employer’s Human Resources department will result in a delay of the payment of my benefit.

Attach a copy of your identification (ID or Passport) and a copy of your KRA PIN/iTax Certificate

Section D - Trustees’ Declaration

It is hereby confirmed and warranted that the information contained hereinabove including the information submitted by the Employer and the member is correct and, in particular, that the member’s banking details provided above have been confirmed as correct.

Copyright:

Copyright in this material is expressly reserved and this form and all attachments (where applicable) remains the exclusive property of Zamara Actuaries, Administrators & Consultants Limited. This form and all attachments (where applicable) may not be copied, stored, retrieved or in any way reproduced without the express written permission of Zamara Actuaries, Administrators & Consultants Limited. Breach of copyright is a serious offence and can lead to litigation.