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Withdrawal Application Education Form

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PW02

WITHDRAWAL APPLICATION FOR LOCAL EDUCATION (TUITION FEES & ACCOMODATION) ASSISTANCE
PLEASE READ THIS NOTE: Before you fill this form, read the Explanatory Notes on Page 3. All sections of this form must be completed. Any person, who knowingly makes a false statement or produces false documents, commits an offence contrary to section 49 of the FNPF Act and is liable to a fine $500 or 1 year imprisonment or both. Consequently, the Fund may also impose restrictions on the withdrawals for the said person. Section A: Particulars of Applicant Name: Fathers/n: Phone/Mobile No.: E-mail Address: Section B: Employment Details Name & Address of Employer: Name & Address of Previous Employer: List any other Previous Employer: Section C: School Fees Details
Details of student Student Name Student ID# Student Relationship Name of Institute Term/Semester Fee I II III Amount Requested Tuition Accommodation

FNPF No. Date of Birth: Gender/Sex: Postal Address: / /

Section D: Payment Authority and Declaration Payment Authority (This authority may be exercised if my application is approved) I hereby apply and authorise for payment to be made to the institute and that it will be deemed a proper discharge by FNPF of funds held in my account. Indemnity I hereby indemnify the FNPF Board from any liability whatsoever, including any loss benefits that may arise as a consequence of approving my Application. Declaration I declare that I have read, understood and answered all the questions. The particulars provided by me are complete and correct to the best of my knowledge. Members Left Thumbprint Signature of member (As in FNPF Records) Signature of Witness (To Members Signature & Thumbprint) Print Name & Address of Witness Date

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OFFICE USE ONLy


Withdrawal Reference Number: Member Details tally with FNPF Record: Yes / NO Checked By: Employment Details tally with FNPF Records: Yes / NO Checked By: All Forms duly completed YES/ NO Signature Tally: YES/ NO Current Balance $ Recommended By: Eligibility $ All documents required attached & checked YES/ NO Last Cont Paid Month/Year: Checked By Amt Recommended $ Signature: Date Date

Withdrawal Authorized- General Manager


Approved Approving Officer Signature Amount Approved: $ Tuition: $ Accommodation: $ Comments Date: Reject

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Guidelines for Education Assistance (Local Schools) This Assistance is available for tuition fees and Accommodation only. Education Assistance guidelines are as follows:1. Assistance is available for the member, members spouse, members children, and members brother/sister. 2. The member must have funds available under education eligibility only. 3. The maximum assistance for Accommodation is $2,000 per student per calendar year. 4. FNPF will make payment directly to the institute/school. 5. The Fund does not assist the following: l Certificate of participation l Payment of arrears of fees l Repayment of outstanding bonds or loans l Online studies with overseas institutes l Reimbursement of fees where funds has been sourced from elsewhere l Examination fees for professional membership Documents to submit with this application The member must apply on the prescribed application form (PW02) for Education Assistance and the completed form and documents of evidence must be original. An application form can only be accepted for processing if ALL of the following information and documents are attached:Tuition Fees 1. Invoice from institute confirming tuition fees to be paid 2. For Special Needs students, an assessment report from a qualified specialist confirming the student/child has special needs or is mentally challenged. 3. Documents confirming relationship of the student to the member. (original/certified true copy of birth certificate/marriage certificate) Accommodation 1. Evidence that the student is enrolled in an FNPF approved institute. 2. Invoice for accommodation from approved institute or hostel. 3. Documents confirming relationship of the student to the member. (original/certificate true copy of birth certificate/ marriage certificate) FNPF reserves the right to request further information if required. Processing Fees A Processing Fee of $10.00 is applicable for all Partial Withdrawals. Do not send cash with your application via mail. Where to lodge this application Your completed application may be lodged at or posted to the FNPF office in Suva, Lautoka and Labasa and agencies in Nadi, Valelevu & Savusavu and Ba.

All Correspondence to be addressed to the General Manager & Chief Executive Head Office Provident Plaza 2 Private Mail Bag Suva Telephone: (679) 330 7811 Facsimile: (679) 330 7611 Valelevu Agency Valelevu Complex Building Saqa Place Valelevu Telephone: (679) 3343 671 Facsimile: (679) 3343 670 Email: information@fnpf.com.fj Lautoka Drasa Avenue Private Mail Bag Lautoka Telephone: (679) 666 1888 Facsimile: (679) 666 5232 Nadi Agency Shop 2 Lalidhar Arcade Namaka Lane Nadi Telephone: (679) 672 8981 Facsimile: (679) 672 8982 Labasa Rosawa Street Private Mail Bag Labasa Telephone: (679) 881 2111 Facsimile: (679) 881 2741 Savusavu Agency Budget Lodge Building Ltd Main Street Savusavu Telephone: (679) 885 3396 Facsimile: (679) 885 3397

Ba Agency Ganga Singh Street, Ba Telephone: (679) 667 0003

Website:www.myfnpf.com.fj

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