This form is only used for disability or death benefits.
1) Please ensure SURNAME, FIRST, MIDDLE names (of person receiving the benefit) match exactly the name on the bank account of the recipient.
2) The form must be authenticated/witnessed by an official of the United Nations or a local governmental authority. Both dates must be the same (the date of the signature and of the authentication).
3) Name, title, signature and official stamp must be affixed to the form.
4) Original form must be sent to the Fund.
5) Please write with black or blue ink.
6)Please ensure that your contact details, telephone and email are updated.
7) Please ensure to check on page 1 the box corresponding to the benefit for which the payment instructions are being submitted.
8) On page 2, the name of the entitled beneficiary (e.g. the surviving spouse, or child, etc.), must be provided, NOT the name of the former staff member/retiree.
Please note that your signature on the Payment Instructions Form must be authenticated. Therefore please sign and date the Payment Instructions Form in front of the person authenticating your signature i.e. a UN official, an officer of a local government authority or a notary public, as he/she needs to attest to the fact that he/she witnessed you signing the Payment Instructions Form. The person authenticating your signature (a UN official, an officer of a local government authority or a notary public ) must affix on the Payment Instructions Form their full name, title, the date they authenticated your signature, and original ink signature, as well as their stamp/seal of office, and, if applicable, also their license or index number. Please note that the dates indicated on the form by the beneficiary and by the official authenticating his/her signature must be the same. The Fund will not accept a Payment Instruction Form on which different dates are indicated.