The accrued benefits under these Regulations shall be paid into a bank account or mobile money account as indicated by the member or through any other mode of payment approved by the board.
10, Terms and conditions for access to midterm benefits The following terms and conditions apply?to midterm access to benefits under these Regulations-
(a)
a member shall not access midterm benefits under both section
20A
(2) and 20A (3) of the Act: and
(b)
payment of the benefits shall be in accordance with the mode of payment specified by the applicant in the application.
APPLICATION FORM FOR MIDTERM ACCESS TO BENEFITS Regulations 5(1) &6(2)
THE NATIONAL SOCIAL SECUIRTY FUND (MIDTERM ACCESS TO BENEFITS) REGULATIONS, 2022
MIDTERM BENEFITS CLAIM FORM
/--------------------- :-----------------------\
REF. NO.................. /........ / | PHOTO WORKFLOW NUMBER............................... JJ i BRANCH......................................................... , PLEASE READ THROUGH BEFORE COMPLETING THIS FORM. USE BLOCK LETTERS THROUGHOUT.
SECTION
1
: BENEFIT CLAIM SPECIFICATION Please tick the appropriate box for the type of Benefit Claim you would like to submit
(1)
10 years' contribution, 45 Years of (1) Person with disability. 10 Years age (20%) contribution and 40 years of age (one-time installment of 50%)
(2)
Percentage applied for (up to 20%)
SECTION
2
: MEMBER DETAILS (1) Surname: ................................................................................................... (2) Other names: ............................................................................................... (3) NSSF Number: ■-■ i-- :-- ;:-I-- -- ---- -- -- I
(4)
Other NSSF number (if applicable)', please indicate in the space provided below. ,
(5)
Nationality....................................................................................................
(6)
Date of first contribution to NSSF (Ifknown).......................................
(7)
National Identification Number/AIien Identification No.................. (8) Date of birth:
(11)
In case of a person with disability, the nature of the disability..........
(a)
Village.................................. (b) Subcounty ......
(c)
County.................................. (d) District.............................
(13)
Current residential address:
(a)
Village.................................. (b) Subcounty ......................
(c)
County.................................. (d) District ..........................
(14)
Telephone number............................
(15)
Email address (If any) ..................
SECTION
3
: EMPLOYMENT RECORD List ail your employers starting with the MOST CURRENT employer (full name of organization) Company Department/ ' Staff ID Number Period of Employment *■ " -Name Section </ ■■■ : - • Number V
1 2 r- ■■ "..........r-....... । -Jn-------- i I 4 5 -- • i 6 I
Continue on additional plain sheet of plain paper if necessary
SECTION
4
: DISABILITY STATUS (FOR PERSONS WITH DISABILITIES ONLY)
(17)
NATURE OF DISABILITY (Please lick the most appropriate as applicable)
(a)
Physical _ _ (b) Vision '__ J (c) Hearing
(d)
Deaf-blind .-_ (e) Little Person __ : (f) Albinism ---- -1 (g) Mental _ _J (h) Neurological _ _ - (i) Multiple _____ -
(18)
When did the disability7 start?..........................................................
(19)
What caused the disability?.............................................................
SECTION
5A
: ELECTRONIC/ BANK FUNDS TRANSFER SECTION
5
: MODE OF PAYMENT
Bank Mobile Money Others (specify)
SECTION
5A
: ELECTRONIC/ BANK FI NDS TRANSFER___ J NSSF NUMBER: 1 " ! • FULL ACCOUNT HOLDER NAMES
CURRENCY (UGX, EURO, GBP, KES, USD, TZS)
TELEPHONE CONTACT BANK BRANCH
SWIFT CODE, SORT CODE AND IBAN No (FOR EURO FOREIGN ACCOUNTS)
CLAIMANTS WITH FOREIGN ACCOUNTS: 1 consent that NSSF pa\ s me in foreign currency based on the prevailing spot exchange rate NSSF's bank will offer:............................................................
SECTION
5B
: MOBILE MONEY (For benefits up-to a maximum of Uganda Shillings 10.000,000 (ten million)
MOBILE PHONE REGISTERED NAMES: (Must be registered under beneficiary's names)
SECTION
6
: FINGER PRINTS
SECTION
6A
: RIGHT HAND FINGER PRINTS (Please indicate with ink the finger print)
LEFT HAND LEFT HAND RIGHTHAND RIGHTHAND THUMBPRINT POINTER THUMBPRINT POINTER
(To be signed in the presence of an NSSF officer)
Claimant's signature:.......................... Date (DD/MM/YYYY):................
Time (12- hour format)'. .............................................................
SECTION
7
: DECLARATION BY NSSF STAFF
I (Name)................................................ (Title)..................................................... hereby confirm that the thumb-prints and photograph attached belong to the claimant and that the claimant has been identified as per documentation provided.
Officer's signature:...................... Date (DD/MM/YYYY)'. .................
Time (12- hour format)'................................................................................ ........
TERMS AND CONDITIONS FOR MODE OF PAYMENT (FOR MOBILE MONEY PAYMENTS) 4
By adopting this particular mode of payment stipulated in section
5
the client agrees to the following;