Revision / Rev. 0
Shared Services
PAYMENT OF MONIES DUE TO AN EMPLOYEE ON DEATH
CONFIDENTIAL
I, the undersigned (state full first names and surname):
______
Unique number: ______Pay centre: ______
Hereby nominate as beneficiary(s) for the direct payment of the following monies due to me by Eskom at the time of my death:
1. Accumulated leave money and pro- rata annual bonus
NAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
2)
2. Eskom death benefit fund R15000 (One nominee over 18 years of age and with active bank account)
NAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
3. Stated benefit
NAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
2)
If any of the abovementioned beneficiaries are legally disabled at the time of my death the amount on behalf of such beneficiaries must be paid out to the following person / organisation.
The people nominated on this page must not be the same as the people on the first page
1. Accumulated leave money and pro-rata annual bonusNAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
2)
2. Eskom death benefit fund R15000 (One nominee over 18 years of age and with active bank account)
NAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
3. Stated benefit
NAME / ID NUMBER / RELATIONSHIP / ADDRESS / %
1)
2)
I also hereby undertake not to attempt, transfer or assign, transfer or otherwise cede, or pledge or hypothecate such monies that may become due to my nominee.
I acknowledge that if any of the aforementioned beneficiaries are minors at the time of my death, the amount will be paid to my estate.
Signed at ______on this ______day of ______20 ___
in the presence of the undersigned witnesses:
WITNESSES:
1. ______
______2. ______
SIGNATURE OF EMPLOYEE
ACCEPTED BY ESKOM:
______
FOR ESKOM DATE
** Kindly note that neither of the witnesses to the above signatures shall be a nominee of the employee completing this form.
FDiv Layout Portrait Template Rev. 0.doc
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Effective February 2010