24.01.2013 Views

Pensions Form NS7 - Ministry of Public Service

Pensions Form NS7 - Ministry of Public Service

Pensions Form NS7 - Ministry of Public Service

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

PENSIONS FORM <strong>NS7</strong> (REVISED 2009) Attach stamp<br />

The Permanent Secretary,<br />

<strong>Ministry</strong> <strong>of</strong> <strong>Public</strong> <strong>Service</strong><br />

<strong>Pensions</strong> Department<br />

Po Box 7003, Kampala<br />

Employer or LC1<br />

1. From: Retiring/ <strong>Public</strong> Officer/Deceased: …………………………………………………..<br />

<strong>Ministry</strong>/District……………………………………………………………………………..<br />

Department…………………………………………………………………………………….<br />

PAB. No. (For deceased soldiers <strong>of</strong> UPDF)……………………………………………………<br />

Address………………………………………………………………………………………<br />

2. PLEASE RECORD THE FOLLOWING RECORDS AND INFORMATION<br />

My address after retiring/ Address <strong>of</strong> the claimant will be:<br />

Name <strong>of</strong> the retiring <strong>of</strong>ficer/ claimant…………………………………………………….<br />

Village/ zone……………………………….. Sub-county/ Division………………………….<br />

County…………………………………….. District……………………………………….<br />

P.O Box…………………………………….. Telephone ……………………………………<br />

3. My pension/gratuity should be to the credit <strong>of</strong> my account at:<br />

Bank………………………………………………. Branch……………………………<br />

Account tittle…………………………………………………………………………….<br />

Account number………………………………………………………………………….<br />

Confirmed by bank manager:<br />

Attach passport size<br />

Photograph <strong>of</strong> claimant.<br />

Name………………………………………. signature and stamp…………………………


4. The following are the members <strong>of</strong> my immediate family:<br />

Spouse(s) (where applicable)<br />

1……………………………………………………………………………………………<br />

2…………………………………………………………………………………………….<br />

Children ( In case <strong>of</strong> deceased, the children <strong>of</strong> the late)<br />

Names Date <strong>of</strong> birth<br />

1…………………………………………… …………………..………………….<br />

2…………………………………………… ……………………………………….<br />

3…………………………………………… ………………………………………..<br />

5. Employer’s certification<br />

i) Head <strong>of</strong> personnel ………………………………Signature and date……………………………<br />

ii) Head <strong>of</strong> Accounts…………………….…………Signature and date…………………………<br />

6. I certify that the above information is correct to the best <strong>of</strong> my knowledge and belief.<br />

Name <strong>of</strong> claimant………………………………………. Signature……………………………….<br />

Date………………………….<br />

N.B.<br />

1. All services by the ministry <strong>of</strong> <strong>Public</strong> <strong>Service</strong> are free<br />

2. In case <strong>of</strong> deceased <strong>Public</strong> <strong>of</strong>ficers, this form should be filled by the beneficiary (S)

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!