CLAIMANT’S PHOTO:

NAPSA RETIREMENT BENEFIT

(i) Application for a Benefit

This form has to be filled in whenever you are applying for any of the Retirement
Benefits payable under the National Pension Scheme Act. Before you complete
this form, please ensure that you carefully read through the instructions below.

(ii) Misrepresentation of Facts

Any person who makes a false statement or representation or produces or
furnishes or causes to be produced or furnished any information which he or she
knows to be false in a material particular is guilty of an offence under Section
51(I) (C) of the National Pension Scheme Act No. 40 of 1996.

(iii) Retirement Pension

To qualify for Retirement Pension you should have met the following
conditions:-

1. You should have attained the pensionable age of 55, 60 or 65 years and,

2. You should have either made at least 180 months of contributions to

NAPSA, or

3. You should have made the minimum number of contributions specified in

the National Pension Scheme (Benefits and Eligibility) Regulations, 2000.

4. You should have made up the minimum required number of 180

contributions by converting your ZNPF balance in accordance with the
provisions of the National Pension Scheme (Benefits and Eligibility)
Regulations, 2000.

5. A member who, otherwise, does not meet the conditions stated on point 1
to 4 but has attained Retirement age of 55, 60 or 65 years instead qualifies
for a Retirement Lumpsum.

(iv) Provisions of the Amended Act No. 7 of 2015

1. The Amendment Act provides for the definition of pensionable age as sixty
(60) years. This means that members joining the Scheme after 14th August
2015 will attain normal retirement age on their 60th birthday.
 2. Early retirement age has therefore been amended to fifty-five (55) years (from
fifty years), while late retirement age will be sixty-five (65) years.

3. The condition for award of early retirement pension is that the member
notifies the contributing employer of their intention to retire twelve months
before attaining the age of 55 years, while for late retirement (at 65 years)
twelve months’ notice must be given to the contributing employer before the
member attains the age of 60 years.

4. The qualifying criteria for award of early, normal and late retirement pension
benefit will be at least one hundred and eighty (180) monthly contributions to
the Scheme. Any member that does not meet this criterion will be paid a lump
sum benefit.

5. A member who has gone on early retirement at 50 years and has a minimum
180 contributions qualifies for Early Retirement Pension.

Note: When a Member is working on contract and is above 55 years but below 65
years, the employer is under obligation to continue deducting NAPSA contributions for
the Member.

(v) Requirements

1 Clear and Certified Photocopy of Members NRC

2 One Passport Size Photo (Less than 6 months old)
3 Clear and Certified Photocopy Certificate of Service/ Retirement
Letter/ letter of Separation. The documents MUST indicate the date of
separation with Names as on NRC.
4 Clearly and correctly completed Bank Declaration Form ( If member
already qualifies for a Pension at claim submission, this form is not
required)
5 ALL Documents requiring certification should be done by a
commissioner for oaths with the Commissioner for Oaths title on the
stamp or The Presiding Magistrate, with an exception to original
documents addressed to NAPSA
Document Receipt Checker CSC CSO RC

RECEIVED BY:……………………………………………………
Man No…………………………………………………………….

VETTED BY:………………………………………………………
Man No…………………………………………………………….

SCANNED BY:……………………………………………………
Man No……………………………………………………………

NPS Form R3 (1/99)

A. MEMBER’S DETAILS (Names and Date of Birth MUST be as per the NRC)

1. NAME
____________________________________________________________
SURNAME MIDDLE NAME FIRST NAME

2. DATE OF BIRTH
____________________________

3. RESIDENTIAL ADDRESS

4. NAPSA SOCIAL SECURITY NUMBER

ONE DIGIT FOR EACH BOX

5. NATIONAL REGISTRATION CARD NUMBER

6. NPF SOCIAL SECURITY NUMBERR (IF ANY)

B. (Field MUST be completed by the last Employer the where the claimant served)

EMPLOYER’S CONFIRMATION OF MEMBER’S SEPARATION OR

RETIREMENT

TO BE COMPLETED BY SOMEONE IN MANAGEMENT / SENIOR OFFICER

Employers Account Number

I confirm that .................................................... was employed by this company and to the

best of my knowledge Separated/ Retired on ........................................................………..

NAME (IN FULL) DESIGNATION SIGNATURE

OFFICIAL
STAMP
NPF form R3 (1/99)

C.
MEMBER'S EMPLOYMENT HISTORY
(The Claimant MUST list down ALL the Companies they worked from 2000 February)

EMPLOYER'S FULL NAME

AND ADDRESS PERIOD EMPLOYED

FROM TO
Month Year Month Year

D.
APPLICANTS PREFERENCE REGARDING ZNPF BALANCE

Please indicate whether you would like your ZNPF balance to be considered for purposes
of computing your benefit.

1. I opt to have my ZNPF balance converted to months of pensionable employment

YES/NO

2. I opt to collect my ZNPF balance as a lumpsum

YES/NO
E.

PARTICULARS OF BENEFICIARIES (Only Spouse(s), Biological and/or legally

Adopted Children)

The Authority reserves the right to apply the applicable rules. This means that some of
the individuals you may list may not receive a benefit because they are not entitled to it
by reason of the rules of the National Pension Scheme Regulations as stipulated in
Statutory Instrument No. 71 of 2000.

SURNAME FIRST DATE OF SEX NRC NUMBER RELATIONSHIP

NAME BIRTH

NPS Form R3 (1/99)

F.

CLAIMANT’S DECLARATION (Field to be completed by the claimant)

1. SURNAME NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

OTHER NAMES: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

2. NRC No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ CONTACT No. _ _ _ _ _ _ _ _ _ _ _

(Or Passport number for Non Zambians)
___________
3. ADDRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_________________________

I hereby declare that to the best of my knowledge the information provided above is
correct.

___________________ ________________
Date Signature and Thumb Print

G.

FOR OFFICIAL USE ONLY

Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Man No.: _ _ _ _ _ _ _ _ _ _

Form received by me on: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

NPS Form R3 (1/99)