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Beneficiary Designation Form

The document is a Beneficiary Designation Form for Glorious Mutanu Daniel, specifying the allocation of final dues from Africa Healthcare Network upon death or incapacitation. It lists two beneficiaries, Jacinta Mueni (mother) and Daniel Katiti (father), each receiving 50%. The form requires a declaration of accuracy and the attachment of beneficiaries' National ID copies.

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immaculateakinyi733
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31 views2 pages

Beneficiary Designation Form

The document is a Beneficiary Designation Form for Glorious Mutanu Daniel, specifying the allocation of final dues from Africa Healthcare Network upon death or incapacitation. It lists two beneficiaries, Jacinta Mueni (mother) and Daniel Katiti (father), each receiving 50%. The form requires a declaration of accuracy and the attachment of beneficiaries' National ID copies.

Uploaded by

immaculateakinyi733
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

BENEFICIARY DESIGNATION FORM

In the event of death or incapacitation, list below the person or people who should receive any
final dues owed to you by Africa Healthcare Network. Kindly indicate the percentages in the
column provided.

1. STAFF DETAILS
Name: ______GLORIOUS MUTANU
DANIEL____________________________________________________________
ID Number:
___39577040_____________________________________________________________

2. BENEFICIARY INFORMATION

ID Number Relationship Phone Permanent


Full Legal Name Percentage
Number Address
JACINTA MUENI 22235767 MOTHER 0717714384 MUTHETHENI 50

DANIEL KATITI 12661917 FATHER 0720838951 MUTHETHENI 50

TOTAL 100% *

* Ensure that the percent allocated to all beneficiaries adds up to 100%

3. DECLARATION

I……GLORIOUS MUTANU DANIEL………………………………………………………………


declare the above information to be true, accurate and complete. I also confirm that the
information has been provided by me without any coercion.

Signature: ____GMD_________________________________ Date:


___15/08/2024___________________ ATTACHMENTS:
Kindly attach copies of Beneficiary’s National ID’s together with this form.

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