Declarator Application Form

Membership Information

CONFIRMATION OF CONSENT TO BE INCLUDED IN EPPF’S DECLARATOR APPLICATION TO REGULARISE MEMBERSHIP OF THE FUND.

Date:

Membership Type *

EPPF Member Details

First Name *

Middle Name

Surname *

Membership Number *

My Contact Details

Email Address *

Cellphone Number *

Address *

Identification Document Type *

Identification Number *

Certified Copy of ID Document*

Please provide a relative’s contact details should EPPF not be able to contact you on your primary email address:

Relationship to you *

Relative's First Name *

Relative's Surname *

Relative's Email Address *

Relative's Cellphone Number *

Declaration

As a member, I confirm that I do not have any documentation, or do not have sufficient documentation, or documentation that can reasonably be relied upon for the purposes of the litigation, that can support or confirm that I was eligible to participate in the Fund at the time of my admission as a member of EPPF. *

As a beneficiary, I confirm that I do not have any documentation, or do not have sufficient documentation, or documentation that can reasonably be relied upon for the purposes of the litigation, that can support or confirm that the main member was eligible to participate in the Fund at the time of their admission as a member of EPPF.*

I confirm that I give consent to be included in the court application to be launched by the Fund to regularise my membership or the main member's membershihp.*

I confirm that EPPF has consulted me and explained the declarator process to me and that I give this consent with full understanding of the process to be undertaken by the Fund.

I also consent to the Fund and/or the Fund’s legal representatives communicating with me throughout the process of obtaining the declarator application.

I further confirm that I consent to the Fund sending all court documents relating to the declarator to my email address including the service of any documentation initiating litigation in the declarator.

Responsible Party Signature

Full Name *

Signature Below *

Other Beneficiary Details

Help us contact other EPPF beneficiaries you know.

Other Beneficiary First Name

Other Beneficiary Surname

Other Beneficiary Cellphone Number

Other Beneficiary

I hereby confirm that I disclose the details of the abovementioned beneficiary with his/her consent.

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