public service department of malaysia post-service division

PUBLIC SERVICE DEPARTMENT OF MALAYSIAPOST-SERVICE DIVISIONJPA.BP.UMUM.BMJAPPLICATION FOR FUNERAL ARRANGEMENT EXPENSESINSTRUCTION1. This form contains 2 pages. Please fill in this form using BLACK / BLUE ink.2. Please use “CAPITAL LETTERS”.ARETIREE’S INFORMATIONName:Current NRIC Number :Old NRIC Number :Pension Account Number :Date of Death :BAPPLICANT’S INFORMATION1. Applicant’s name2. Current NRIC Number3. Old NRIC Number4. Relationship5. Bank account number6. Bank7. Address8. Postcode 9. Town 10. State11. Phone number 12. E-mail (if applicable)

CDECLARATIONI …………………………………………………………………………………………………… (Name)NRIC Number ……………………………………………………………………….. hereby certifythat the information given in section A and B are true and I declare that I am the person in charge of theretiree’s funeral arrangements as stated in section A. I will be responsible for any claims to the governmentby any party with regards to funeral arrangement expenses after this.(Signature of applicant)DateDocuments to be attached*1. Copy of death certificate2. Copy of retiree’s NRIC3. Copy of applicant’s NRIC3. Copy of applicant’s front page bank account3. Confirmation letter from last department or other documentation which certify deceased as governmentofficer (for government retirees under EPF scheme)6. Documents showing the relationship between retirees and recipients:Pemohon /ApplicantWidow or WidowerChildrenParentsOthersDokumen/DocumentCopy of marriage certificateCopy of birth certificateCopy of retiree’s Birth CertificateLetter of Oath*Verification can be made before Kadhi, Imam, Priest, Village Headman Or Chief, Community Leader, Head Of Police Station, HeadMaster/Mistress, Government Officer(Top Management, Management And Professional Groups), Anak Negeri Head