Section A - Member’s particulars

(please complete in full)



Section B - Declaration by the employee

I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Section C - Declaration by the employer

Does the information provided by the Employee in the section above agree in all respects with your staff records?



I hereby declare that the above statements are true and correct to the best of my knowledge and belief.

Copyright:

Copyright in this material is expressly reserved and this form and all attachments (where applicable) remains the exclusive property of Zamara Actuaries, Administrators & Consultants Limited. This form and all attachments (where applicable) may not be copied, stored, retrieved or in any way reproduced without the express written permission of Zamara Actuaries, Administrators & Consultants Limited. Breach of copyright is a serious offence and can lead to litigation.