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Beneficiary Form

This document is a beneficiary form for Internews Network in Nairobi, Kenya. It allows an employee to nominate primary and contingent beneficiaries to receive death benefits. The employee provides their name and ID number and can list up to three primary beneficiaries, specifying each person's name, date of birth, relationship and proportion of benefits. If a primary beneficiary predeceases the employee, their listed benefits will pass to any contingent beneficiaries instead. The employee signs and dates the form and can change their beneficiary instructions at any time.

Uploaded by

Joyce Nyakio
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
71 views

Beneficiary Form

This document is a beneficiary form for Internews Network in Nairobi, Kenya. It allows an employee to nominate primary and contingent beneficiaries to receive death benefits. The employee provides their name and ID number and can list up to three primary beneficiaries, specifying each person's name, date of birth, relationship and proportion of benefits. If a primary beneficiary predeceases the employee, their listed benefits will pass to any contingent beneficiaries instead. The employee signs and dates the form and can change their beneficiary instructions at any time.

Uploaded by

Joyce Nyakio
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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INTERNEWS NETWORK

NAIROBI, KENYA

BENEFICIARY FORM

I, ………………………. of I.D NO: …………………. and currently employed as


………………………. at Internews Network do hereby nominate the following
person(s) to receive the benefits payable to me or for my benefit in the event
of my death.
The benefits shall be paid wholly to my named beneficiary or where more
than one beneficiary is named then in the proportions specified against the
named beneficiary. In the event that the primary beneficiary(s) pre-deceases
me then the benefits payable to that beneficiary(s) shall be paid to the
contingent beneficiary(s) below mentioned wholly in equal shares
Primary Beneficiary

1. Name: ……………………
Date of Birth: ……………….. Relationship to Employee:
……………………..
Proportion: ……………..

2. Name: ………………………………………………..
Date of Birth: ……………………. Relationship to Employee:
……………………
Proportion: ……….

3. Name: __________________________________________________________
Date of Birth:___________________ Relationship to
Employee:_____________
Proportion:_____________

Contingent Beneficiary

1. Name: __________________________________________________________
Date of Birth:___________________ Relationship to
Employee:_____________

2. Name: __________________________________________________________
Date of Birth:___________________ Relationship to
Employee:_____________
3. Name: __________________________________________________________
Date of Birth:___________________ Relationship to
Employee:_____________

I __________________________________ reserve the right to change the


instructions herein at any time.

Signature of Employee ___________________________________________

Date of Signature __________________________________

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