Online Withdrawal Form

General Information & Requirements

Please select the dropdown below for withdrawal information & requirements.

Medical

Who can receive this assistance?

Member
Member’s Spouse
Member’s Parents
Member’s Siblings
Member’s Children

What am I entitled to?

The amount applied must be within the member’s General Account entitlement.
Assistance may also be extended for incidental expenses for overseas medical treatment to a maximum of $10,000 for those not covered under any Insurance scheme and $5,000 to those covered by Insurance Scheme, per patient per calendar year.
For review cases, the Fund may assist upon receipt of recommendation from overseas consultant.
Assistance may be provided for prosthetic, hearing aid and wheelchair. Payment will be made directly to the supplier

Who needs to complete this form?

Member

Where can I lodge this form?

Members can:

Submit online
Email to

Required documents

Local Medical Treatment

Recent detailed medical report from a registered local doctor.
Breakdown of treatment cost from medical institution where the patient is undergoing treatment.
Evidence of own contribution or receipts of payments made indicating that you have offset the balance of the cost of full treatment if your general account entitlement is less than 50% of the full cost.
Evidence of relationship of the patient to the member.

Overseas Medical Treatment

Confirmation letter from overseas hospital on patient’s treatment, date of admission, length of stay and breakdown of cost of treatment.
Letter from insurance company confirming that you have a medical insurance cover and details of the cover.
Certified copies of patient’s passport pages showing the details of the passport holder and the validity of the passport.
Visa covering the period of medical treatment is to be produced before payment is released.
Breakdown of incidental expenses during the review period.
Latest bank statement. (no more than one month old).
Evidence of own contribution or receipts of payments made indicating that you have offset the balance of the cost of full treatment if your general entitlement is less than 50% of the full cost.
Evidence of relationship of the patient to the member

Funeral

Who can receive this assistance?

Member’s Spouse
Member’s Parents
Member’s Siblings
Member’s Children

What am I entitled to?

The amount applied for must be within the member’s General Account.
The maximum withdrawal permitted is $2000 for each funeral.

Who needs to complete this form?

Member

Where can I lodge this form?

Members can:

Submit online
Email to

Required documents

Documentary evidence is required to confirm the relationship between the member, deceased person and the person declaring
If applying for assistance for the death of a sibling, a statutory declaration is required from the next of kin or other siblings authorizing you to receive assistance and confirm the marital status of the deceased
Latest bank statement. (no more than one month old).
Original or certified birth certificate printed after year 2000 of deceased member (latest extract from the Registrar General’s Office containing the “deceased” water mark will be required for members who died overseas).
Medical Certificate of Cause of Death stamped & signed by the authorised medical official OR Death Certificate.

Unemployment

*Important Note:

This is not the COVID 19 assistance form.
For COVID 19 assistance form, please liaise directly with your employer.
Only your employer is authorised to submit in the COVID 19 assistance form.

Who can receive this assistance?

Members who have:

Been terminated
Resigned

What am I entitled to?

Maximum of $1000.00 as per General Account entitlement.

Who needs to complete this form?

Member

Where can I lodge this form?

Members can:

Submit online
Email to

Requirred Documents

Letter from employer stating termination, non-renewal of contract, laid off, redudancy or seasonal worker.
Acceptance letter of resignation from employer.
Member must apply for this assistance within 6 months from the date of unemployment.
Resignation on own accord and cases pending disciplinary tribunal can be assisted after 3 months from the last date of employment.
Member's birth certificate printed after year 2000.
Valid Bank Statement

Section A: Personal Details

Withdrawal Type

FNPF ID

Acceptable FNPF number formats: MN12345678X, 2345678 or AB678

Full Name

As in birth certificate

TIN No.

Do not include hyphens (-)

Birth Registration Number

Date of Birth

Email

As registered with FNPF.

Mobile Number

As registered with FNPF. We will contact you on this number for clarification.

Phone Number

Alternative phone contact.

Residential Address

Section B: Medical Details

Please complete and provide the required information relating to medical treatment received by you or your immediate family member.

Patient's Name

FNPF ID

Relationship

Relationship to Member

Medical Institute

Treatment Cost

Incidental Cost

Accommodation Cost

Doctors Cost

Total Cost

Section C: Funeral Assistance

Please specify details of deceased person.

Name of Deceased

FNPF ID

TIN

Do not include hyphens (-)

Medical Certificate No.

Death Certificate No.

Birth Registration No.

Date of Birth

Date of Death

Place Of Death

Place Of Burial

Date Of Burial

Section H: Unemployment Assistance

Please specify employment details relating to this withdrawal.

Date of Termination

Detailed Employment History

Please state your Employer Name & Period of Employment

Section D: Payment Details

You are required to complete this section specifying method of payment and details

Direct Deposit

Local Bank (Direct Deposit)

Overseas Bank (Direct Deposit)

Telegraphic Money Order (TMO)

Mobile Money (Vodafone, Inkk, Digicel)

Bank Account Details

Account Name

Bank Name

Account No:

BSB/Routing No.

Swift Code

Bank Address

Telegraphic Money Order

Full Name

Nearest Post Office/Agency

Mobile Money Details

Full Name

Mobile Phone Number

Service Provider

Requested Amount

Section E: Document Upload

File Type should be in pdf,docx,doc,png,jpg. Max. Limit per file size is 2MB.

Death Certificate/Medical Cause of Death/Medical Referal Forms/Resignation or Termination Letter

Breakdown of Treatment Costing.

This field is only applicable if you choose withdrawal type as Medical (Local OR Overseas)

Birth Certificate of Deceased or Patient

This field is only applicable if you choose withdrawal type as Medical OR Funeral

Birth Certificate of Member

Latest Bank Statement

For withdrawals under Medical & Funeral you are required to submit in your latest bank statement.

Section G - Declaration

I understand and agree that:

(a) I have read, understood and answered all the questions and the particulars provided by me are true and correct.

(b) I hereby indemnify the FNPF Board from any liability whatsoever, including any loss of benefits that may arise as a consequence of approving my Application.

(c) My application is subject to the provisions in the FNPF Act 2011, Section 59 and all such rules or guidelines that may be imposed from time to time.

(d) This authority may be exercised if my application is approved and I hereby apply and authorize for payment to be made.

(e) Any misuse of funds may result in prosecution and the Fund reserves the right to stop further withdrawals in cases of any such misuse.

(f) I understand that I am responsible for the confidentiality of information received through the preferred communication medium. I hereby indemnify the Fund from any liability whatsoever, including the loss of privileged information received through the preferred communication medium.

I Agree